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Columbus Dispatch @DispatchAlerts
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This is Elvin Weir. He is battling Stage 4 colon cancer — and a convoluted healthcare system that forced him to wait weeks for chemo pills. That’s because insurance only covers the pricey drugs if filled through a specific mail-order pharmacy: AllianceRx.
2/ Weir isn’t the only one, cancer-care providers and pharmacists say. Instead of getting drugs at their treatment centers, Ohio cancer patients are forced to use mail-order pharmacies for insurance to cover medications. And cancer’s no waiting game.
3/ This is thanks to insurers and pharmacy benefit managers, or PBMs — little-known but powerful healthcare middlemen. The Dispatch’s reporting shows PBMs often direct patients to their own mail-order pharmacies, meaning they get a cut of the profits.
4/ Insurers and PBMs tout mail-order as convenient. But in Weir’s case, the pills he needed were on the shelf at his treatment center, Zangmeister. His insurer, Blue Cross Blue Shield of Michigan, gave no clear answer to why he instead had to use AllianceRx’s mail-order system.
5/ The Dispatch has spent months investigating pharmacy benefit managers’ powerful influence on Ohio healthcare. Here’s a primer on how the system works, and what exactly pharmacy benefit managers do:…
6/ In March, the Dispatch reported on pharmacists’ claims that CVS Caremark, the pharmacy giant’s benefit manager, is driving independent pharmacies out of business by reimbursing them less than drugs cost.
7/ Pharmacists claimed that pharmacy benefit managers are using “spread pricing” to boost profits. That’s when a PBM reimburses a pharmacy less than it bills an insurer, pocketing the difference.
8/ Last fall, CVS Caremark slashed reimbursements for generic Suboxone, used to treat opioid addiction — so much that some Ohio pharmacies stopped stocking it. After an outcry, CVS back-peddled. But it’s unclear why they were slashed in the first place.
9/ As CVS expands in Ohio, the state’s number of independent pharmacies is dropping. CVS’s “acquisition unit” wrote to many pharmacies squeezed by the low Medicaid reimbursements we reported on, asking they wanted to sell their business.…
10/ CVS Caremark, the pharmacy benefit manager, has also contacted Ohio Medicare recipients to suggest they transfer their prescriptions to CVS-affiliated pharmacies to save money. Critics say it’s part of a pattern of CVS attempting to stifle competition.…
11/ There’s more. In 2012, the Federal Trade Commission closed an investigation into allegations of CVS engaging in anti-competitive practices like patient steering and spread pricing. The agency said it would “not take any additional action at this time”…
12/ Help us continue reporting! Share your experience, or ask friends and family to share their stories. How do you get your cancer drugs? Do you use mail-order pharmacies for prescriptions? Contact reporter Marty Schladen at 614-469-6218 or
13/ Here’s more of our reporting on PBMs:

State probing whether PBMs are overcharging taxpayers:

Ohio workers’ comp exec on pharmacy setup: ‘We were being hosed’

House committee OKs crackdown on PBMs
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