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Ohio Medicaid Seeks Proposals for Third Party Pharmacy Benefit Auditor


Lisa Lawless, Communications Director, Ohio Department of Medicaid
614-813-5358 ǀ lisa.lawless@medicaid.ohio.gov

Ohio Medicaid seeks proposals for third party pharmacy benefit auditor

Increased transparency and accountability focus of independent vendor charged with oversight of Medicaid’s Single Pharmacy Benefit Manager (SPBM).

COLUMBUS, Ohio – Today the Ohio Department of Medicaid (ODM) released its request for proposals (RFP) inviting bids for its pharmacy operations support vendor (POSV). The POSV will strengthen ODM’s fiscal stewardship of the $3 billion pharmacy benefit program by assisting the agency with two critical functions:

  • Pharmacy reimbursement and benefits design.

  • Pharmacy program performance monitoring and financial oversight.

ODM strategically unbundled several components of the current managed care structure to introduce greater transparency, oversight, and specialization for the future program. The POSV, once implemented, will enable ODM to segregate fiscal oversight from benefits administration of the pharmacy program. ODM will leverage the vendor’s extensive industry knowledge to innovate pricing methodologies and create sustainable visibility in Medicaid’s pharmacy reimbursement models.

“The POSV will ensure monetary incentives are properly and fairly aligned, eliminate self-dealing and steering, and monitor and close potential pricing or rebate loopholes,” said Maureen Corcoran, director of ODM. “In short, the POSV ensures that the fox is no longer guarding the chicken coop.”
The selected vendor will be independent from the single pharmacy benefit manager (SPBM). As such, it will objectively monitor the SPBM, conduct cost of dispensing surveys using empirically sound practices, and consult with ODM to maintain rate accuracy.

The RFP will be posted until Dec. 18. Bidders can learn more about the POSV procurement process and goals at Medicaid’s managed care procurement website.