Last week, we were met with a delightful surprise as we were perusing through the CMS website and discovered an out-of-the-blue drug pricing data update just begging to be downloaded. The hidden treasure was the freshly-updated CMS State Utilization database, which provides quarterly drug pricing data that shows what state Medicaid programs are spending on prescription drugs, providing an excellent window into the price-setting practices of the prescription drug supply chain. This most recent CMS data update ended up filling in most of the Q3 2018 divots and extended the 2018 data to include large portions of the fourth quarter. We have updated all of our dashboards that rely on this dataset, rolling all of them forward to Q4 2018. We couldn't resist sneaking an extended peak at the data, and while we will offer more in-depth analyses soon, we wanted to give some of our initial takeaways.
As drug pricing scrutiny grows, PBM spread pricing of cheap, generic drugs is becoming a hot topic of conversation in states across the country. After the state of Ohio opened the books thanks to an audit from the state auditor, the uncovered $224 million PBM spread now has other states scrambling to see what they are being charged as well. One of those states is Pennsylvania, where their state auditor is trying hard to get the data he needs to see where the money is going in the third largest managed care program in the country. Since there are many folks wondering what’s going on in Pennsylvania, considering the current lack of hard data, we decided to dig into the publicly available data to see if Pennsylvania appears to have the makings of an “Ohio problem.”