PBMs got big markup in New York, pharmacists say

A Bloomberg analysis of Medicaid prescriptions at independent pharmacies in the state of New York concludes that PBMs are taking increasingly large markups on generic drugs.

A Bloomberg analysis of Medicaid prescriptions at independent pharmacies in the state of New York concludes that PBMs are taking increasingly large markups on generic drugs. Small pharmacy owners have been complaining for years that PBMs have been shortchanging them, cutting to unsustainable amounts the reimbursement they get for dispensing prescriptions. Community pharmacies have also claimed that PBMs are charging larger per-prescription amounts to their insurer and employer clients, and sometimes pocketing the difference. The new analysis sponsored by the Pharmacists Society of the State of New York is one of the first efforts to quantify that spread in private Medicaid plans that cover about 4.3 million New York state residents. The state society has been a critic of the PBM industry and represents pharmacy owners upset over declining reimbursements. In 2017, PBMs paid independent New York pharmacies in the analysis an average of $10.85 per generic-drug prescription. Private health plans that provide state-financed Medicaid coverage reported a cost of $14.34 per prescription. That represents a markup of 32% over what pharmacies were paid. The markups by PBMs more than doubled from 2016, according to the analysis.