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Ohio Medicaid selects Myers and Stauffer as Pharmacy Pricing and Audit Consultant

For immediate release: April 14, 2021

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

Ohio Medicaid selects Myers and Stauffer as Pharmacy Pricing and Audit Consultant

Vendor to help ODM introduce an unparalleled level of financial checks and balances to the $3.5 billion medication benefit

COLUMBUS, Ohio — Today the Ohio Department of Medicaid (ODM) announced Myers and Stauffer as its Pharmacy Pricing and Audit Consultant (formerly known as Pharmacy Operational Support Vendor). In this capacity, the firm will serve a critical role in bringing greater transparency and accountability to the state’s Medicaid prescription drug benefit.

The Pharmacy Pricing and Audit Consultant (PPAC) will work with ODM to establish pharmacy prices and conduct fiscal oversight of the single pharmacy benefit manager (SPBM). PPAC oversight is designed to eliminate potential SPBM conflicts of interest, prevent prescription drug steerage, and guard against other potential financial mechanisms that could reduce public confidence, increase cost, and obscure visibility into the operations of the program.

“Ohio Medicaid will work hand-in-hand with Myers and Stauffer to create rigorous checks and balances needed to make sure we are using dollars wisely,” said Maureen Corcoran, Ohio Medicaid director.

As the PPAC, Myers and Stauffer will be responsible for determining reimbursement methodologies, conducting dispensing and ingredient acquisition assessments, and maintaining accurate and up-to-date pharmacy rates. The firm will oversee the fiscal performance of Medicaid’s SPBM and fee-for-service pharmacy benefits administrator.

In 2018 and 2019 former State Auditor Yost and the Columbus Dispatch validated a Health Data Solutions study commissioned by ODM that reported $224 million in Medicaid PBM payments could not be verified or accounted for.

“Ohio’s next generation managed care structure is designed for transparency and accountability,” Corcoran said.  “The PPAC will bring visibility to the financial influences and levers associated with pharmacy administration, strengthening Ohio’s ability to fully leverage the pharmacy benefit program for the good of the people we serve and the financial best interest of the state.”

The increased emphasis on program accountability and fair pricing resulting from the partnership between Ohio Medicaid and the PPAC enables the state to:

  • Ensure individuals have access to a variety of pharmacies throughout the state, including in small and rural communities.
  • Establish fair and equitable dispensing and drug acquisition reimbursements for pharmacies statewide.
  • Optimize manufacturer rebates to bring greater value to Ohio taxpayer dollars.
  • Design and introduce value-based innovations that improve care and serve Ohioans better.

Myers and Stauffer earned the highest technical evaluation score among the three proposals received and proposed a fee below that which ODM projected. The firm brings more than 40 years of pharmacy management experience and conducted more than 100 pharmacy cost of dispensing survey projects in more than 30 states. It provides complex data analysis, fiscal modeling, and rate setting services for pharmacy programs across the country. Additionally, Myers and Stauffer is the sole contractor to the Centers for Medicare and Medicaid Services for the development and maintenance of the National Average Drug Acquisition Cost (NADAC) pricing benchmark – a tool to assist states in responding to the quickly changing prescription drug environment.

Medicaid’s PPAC was originally referred to as the “Pharmacy Operational Support Vendor.” The program name was revised to better reflect the role and purpose of the program. The PPAC contract is a two-year term with six additional option years and is valued at $1.5 million per year, or approximately $12 million for the entire 8-year period.

ODM began implementing select elements of its next generation managed care program and will continue to make advancements throughout 2021. The newly designed program is targeted for launch in early 2022.

For more information about Ohio Medicaid’s redesigned managed care program and the future pharmacy benefit program, visit https://managedcare.medicaid.ohio.gov.