Prognosis
Drug Middlemen Got Big Markup in New York, Pharmacists Say
- CVS, Express Scripts, OptumRx dominate PBM market in the U.S.
- Study sponsored by pharmacist group upset over reimbursement
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Pharmacy-benefit managers are taking increasingly large markups on generic drugs in New York, according to an analysis of Medicaid prescriptions at independent pharmacies in the state.
In Medicaid, private insurers are paid by the state to cover low-income citizens. The insurers in turn usually contract with pharmacy-benefit managers, or PBMs, paying them to provide drug coverage. PBMs run by CVS Health Corp., Cigna Corp. and UnitedHealth Group Inc. then bill insurers for coverage, and reimburse pharmacies for drugs.