Pharmacy benefit managers (PBMs) - little-known middlemen in the supply chain that gets prescription drugs from manufacturers to consumers - receive hundreds of millions from Ohio taxpayers via the state’s Medicaid program.

A state-sponsored study conducted after several weeks of Dispatch stories found the PBMs are charging Ohioans 3 to 6 times the normal rate - costing taxpayers an extra $150 million to $186 million a year.

The PBMs use “spread pricing,” meaning they get about $225 million more a year from the state than they reimburse pharmacies for drugs used by Ohio’s poor and disabled.

At the same time the payments to pharmacies were being cut by the PBMs, the parent company of one of them, CVS, sent out letters to pharmacy owners sympathizing with their financial woes and offering to buy them out. This occurred in several states.

PBMs cut the reimbursement rate so much for Suboxone that many pharmacies were forced to stop stocking the drug used by numerous Ohio addicts in recovery.

The Medicaid official who was in charge of dealing with pharmacists who complained about low reimbursements from CVS’s PBM was at the same time, she was a part-time pharmacist with CVS Pharmacy. While still on the job at Medicaid, she negotiated a new job with CVS Caremark, the company whose reimbursements Ohio pharmacists were complaining about.

Ohio Medicaid officials don’t want to follow the example of West Virginia, which eliminated PBMs and saved $38 million, saying it would actually cost the Buckeye State more. Medicaid also is not following the example of the Ohio Bureau of Workers’ Compensation revamp of its prescription drug setup, with one BWC official saying “we were being hosed” under the previous deal.

The city of Columbus wound up doling out $8,000 a prescription for a pain cream that drug salespeople marketed as “free” to individual members of safety forces.

People diagnosed with cancer sometimes must wait weeks to get medication because PBMs required it to be provided by their company’s own mail-order facility, instead of having the patient get it down the hall in the same facility where they were diagnosed.

Rebates drive up the cost of prescription drugs, although their exact impact is cloaked.

A state proposal to provide HIV drugs seems to have been written so that only CVS could get it