美国国家公共电台 NPR States Question Costs Of Middlemen That Manage Medicaid Drug Benefits

 

DAVID GREENE, HOST:

All right. We've been reporting on how state Medicaid programs are struggling to keep up with rising prescription¹ drug costs. States spend more than $30 billion a year on medications for the poor and disabled. Now, some states are taking aim at the companies that manage prescription drug plans and who claim to keep prices low. NPR's Alison Kodjak reports that some states, like Ohio, are finding these companies may be doing just the opposite.

ALISON KODJAK, BYLINE²: So Ohio Medicaid paid two companies $2.5 billion for prescription drugs. Those companies - CVS Health and Optum - paid pharmacies³ just $2.3 billion for the same medications. And they pocketed the remaining 224 million, which was about 8.8 percent of Medicaid's total prescription drug spending. So the question Ohio officials are asking - is that too much to pay a middleman to manage the state's prescription drug plan? I asked Antonio Ciaccia, who's a lobbyist for the Ohio Pharmacists Association.

ANTONIO CIACCIA: I would love to tell you that 8.8 percent is too high, too low or normal, but I'm really unqualified to say that because our state Medicaid program is the first state in the country to really get this level of transparency into how this works.

KODJAK: But he does have an opinion...

CIACCIA: I think 8.8 percent is insane.

KODJAK: ...And so do several officials in Ohio. The attorney general and the state auditor⁴ are both investigating. Ohio Medicaid wants to release a detailed⁵ report on the program, but CVS Health and Optum went to court to block the release, saying the report contains trade secrets. If the analysis is released, it'll offer an unprecedented⁶ window into the opaque⁷ world of drug pricing.

STACIE DUSETZINA: I think that Ohio's going to have an uphill battle when it comes to releasing this information. It's going to be fought very hard by CVS because I think it would set a standard for transparency and providing the public with this information.

KODJAK: That's Stacie Dusetzina, a professor of health policy at Vanderbilt University School of Medicine. She says efforts in other states to reveal drug pricing secrets have failed. CVS declined to speak on tape for this story. In a written statement, the company pointed⁸ out that the summary of the state's report that was made public concluded that using companies like CVS Health saved $145 million overall.

Still, Ohio isn't alone in questioning the value of the middleman. West Virginia last year stopped using pharmacy⁹ benefit managers altogether, and Kentucky is also doing an analysis of its costs. In Iowa, State Representative John Forbes, who's also a pharmacist, launched his own investigation¹⁰ a few months ago after hearing complaints.

JOHN FORBES: We went through the records for this county over about a three-month period and found that, in many cases, pharmacies were being paid $5 to $10 for prescriptions¹¹, but the county entity¹² was being billed over a hundred dollars for those same prescription medications.

KODJAK: Forbes says the oversight¹³ committee in Iowa's legislature now plans to investigate as well. Alison Kodjak, NPR News.

(SOUNDBITE OF U137'S "ADAM FOREVER")

1 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

2 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

3 pharmacies   

药店

参考例句：

• Still, 32 percent of the pharmacies filled the prescriptions. 但仍然有32%的药剂师配发了这两张药方。 来自互联网
• Chinese herbal pharmacies, and traditional massage therapists in the Vancouver telephone book. 中药店，和传统的按摩师在温哥华的电话簿里。 来自互联网

4 auditor   

n.审计员，旁听着

参考例句：

• The auditor was required to produce his working papers.那个审计员被要求提供其工作底稿。
• The auditor examines the accounts of all county officers and departments.审计员查对所有县官员及各部门的帐目。

5 detailed   

adj.详细的，详尽的，极注意细节的，完全的

参考例句：

• He had made a detailed study of the terrain.他对地形作了缜密的研究。
• A detailed list of our publications is available on request.我们的出版物有一份详细的目录备索。

6 unprecedented   

adj.无前例的，新奇的

参考例句：

• The air crash caused an unprecedented number of deaths.这次空难的死亡人数是空前的。
• A flood of this sort is really unprecedented.这样大的洪水真是十年九不遇。

7 opaque   

adj.不透光的；不反光的，不传导的；晦涩的

参考例句：

• The windows are of opaque glass.这些窗户装着不透明玻璃。
• Their intentions remained opaque.他们的意图仍然令人费解。

8 pointed   

adj.尖的，直截了当的

参考例句：

• He gave me a very sharp pointed pencil.他给我一支削得非常尖的铅笔。
• She wished to show Mrs.John Dashwood by this pointed invitation to her brother.她想通过对达茨伍德夫人提出直截了当的邀请向她的哥哥表示出来。

9 pharmacy   

n.药房，药剂学，制药业，配药业，一批备用药品

参考例句：

• She works at the pharmacy.她在药房工作。
• Modern pharmacy has solved the problem of sleeplessness.现代制药学已经解决了失眠问题。

10 investigation   

n.调查，调查研究

参考例句：

• In an investigation,a new fact became known, which told against him.在调查中新发现了一件对他不利的事实。
• He drew the conclusion by building on his own investigation.他根据自己的调查研究作出结论。

11 prescriptions   

药( prescription的名词复数 )； 处方； 开处方； 计划

参考例句：

• The hospital of traditional Chinese medicine installed a computer to fill prescriptions. 中医医院装上了电子计算机来抓药。
• Her main job was filling the doctor's prescriptions. 她的主要工作就是给大夫开的药方配药。

12 entity   

n.实体，独立存在体，实际存在物

参考例句：

• The country is no longer one political entity.这个国家不再是一个统一的政治实体了。
• As a separate legal entity,the corporation must pay taxes.作为一个独立的法律实体，公司必须纳税。

13 oversight   

n.勘漏，失察，疏忽

参考例句：

• I consider this a gross oversight on your part.我把这件事看作是你的一大疏忽。
• Your essay was not marked through an oversight on my part.由于我的疏忽你的文章没有打分。