West Virginia a possible model for cheaper prescription drug prices

Faced with increasing costs in 2017, and already spending $650 million a year on prescription drugs, officials in West Virginia decided they could do better without the plans and their hand-picked PBMs. West Virginia's Medicaid system uses the West Virginia University School of Pharmacy to recommend drugs for patients.

Faced with increasing costs in 2017, and already spending $650 million a year on prescription drugs, officials in West Virginia decided they could do better without the plans and their hand-picked PBMs. West Virginia's Medicaid system uses the West Virginia University School of Pharmacy to recommend drugs for patients. That saved the state $30 million in one year. "They felt the cost was not sustainable," says Vicki Cunningham, West Virginia Medicaid's director of pharmacy services, about the position of state financial officials. "The system we have now is the system we had before we carved pharmacy into managed care" in 2013. West Virginia turned to experts at the state university. They advise providers and make decisions about when it's best to use off-formulary drugs—even though they might cost more and might not come with rebates. Because university employees are not concerned with corporate profits, their only goal is to bring about the best health outcomes, which in the long run saves everybody money, Stevens says. Those who have run a couple of models express confidence that they can do it in Ohio. The head of Cleveland Clinic Pharmacies, Scott Knoer, says his formulary committee manages drugs for pharmacy employees and their dependents much like Ohio State does for its hospital patients. Having that control has saved the group more than $33.6 million to provide health care to employees at 18 pharmacies.