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CMS seeks to limit ’spread pricing’ by PBMs in managed care
Modern Healthcare

The CMS is concerned that some Medicaid managed care plans are not accurately reporting “spread pricing,” a tactic where pharmacy benefit managers charge a plan more for a drug than it reimburses a pharmacy. The agency released a regulatory guidance on Wednesday intended to help states monitor and audit Medicaid and CHIP managed care plans to identify spread pricing when calculating their medical loss ratio (MLR). The guidance clarified that plans must include a PBM rebate in calculating an MLR if the PBM used a subcontractor.