The Ohio Board of Pharmacy is holding a hearing in response to findings made at a CVS in Canton, OH on Sept. 13, 2021. They found a pharmacy so understaffed that the inside counter was closed, stock — including controlled substances — hadn’t been shelved, and customers had to wait in a drive-through line that could take more than an hour to get through and still end with patients not getting their medicine. The pharmacy board, the state’s regulator, could levy fines against CVS, or it could revoke its license for store No. 2063 in Canton. But the hearing has implications well beyond that. The hearing could be the first of about a dozen for Ohio CVS stores the Board of Pharmacy has issued citations against.

Ohio legislators are once again attempting to transform the state’s medical marijuana control program after a similar effort stalled out last year. Proponents of the proposed legislation, Senate Bill 9, seek to expand medical marijuana access to Ohioans and revamp the structure of the current program. The proposal would establish the Division of Marijuana Control (“DMC”) under the Department of Commerce. The DMC’s responsibilities would include licensing cultivators, processors, retail dispensaries, and testing labs, as well as overseeing patient registration – duties that are currently handled by the Board of Pharmacy. The bill would expand the “qualifying medical conditions” that allow a physician to recommend medical marijuana to patients to include autism spectrum disorder and opioid use disorder.

In a recent lawsuit, the State of Ohio has accused certain pharmaceutical benefit managers, or “PBMs,” of violating state antitrust laws.  According to the complaint, the PBMs have leveraged their market dominance to enrich themselves in multiple ways at the expense of other market participants and consumers in Ohio. The complaint names as defendants PBMs Express Scripts, Prime Therapeutics, and Humana Pharmacy Solutions.  It also names as a defendant Ascent Health Services, a group purchasing organization of which Express Scripts is a controlling owner. The Ohio Attorney General’s complaint is but one of the many recent efforts by government actors to rein in PBMs’ perceived anticompetitive practices.

Ohio Attorney General Dave Yost filed a lawsuit against Cigna/Express Scripts, Prime Therapeutics, and Ascent. In the complaint, Yost accuses pharmacy benefit managers Express Scripts and Prime Therapeutics of colluding with Ascent, based in Switzerland, to illegally drive up drug prices which resulted in higher out-of-pocket costs for patients. Additionally, the state of Ohio argues, “PBMs also use their market power to hurt competing pharmacies, and particularly independent pharmacies.” Read Yost’s complaint here.

The Ohio state budget is proposing a 5.7 percent increase to the Medicaid dispensing fee. The transition to the single PBM was cost-neutral and did not adequately address pharmacies’ cost to dispense. The proposed increase is based on results from the November 2022 cost of dispensing survey. More information about the upcoming changes, including a value-based supplemental dispensing fee, can be found in this Medicaid budget overview.

UnitedHealth Group Inc's OptumRx unit has agreed to pay $15 million to settle claims that it overcharged Ohio's worker's compensation agency for prescription drugs. In 2019, Ohio sued OptumRx in the Franklin County Court of Common Pleas, accusing it of overcharging the state nearly $16 million. The state said the company failed for nearly three years to provide agreed-upon discounts for generic drugs purchased by injured workers submitting claims to the Ohio Bureau of Workers' Compensation. OptumRx and other PBMs are facing a federal investigation over their role in surging drug prices, as well as new regulations from states.

Three of the country's largest pharmacy chains — CVS, Walgreens, and Walmart —  will have to pay $650.5 million over the next 15 years to two Ohio counties for their role in the opioid epidemic, a U.S. federal judge has ordered. The decision follows a 2021 verdict that found the three chains continued to dispense significant quantities of opioids even through there were obvious signs of abuse. Together, the chains will pay one-third of the cost the counties will need to deal with the damage the opioid crisis caused.

The Ohio Board of Pharmacy recently approved 70 provisional licenses for new medical marijuana dispensaries in the state. A provisional license requires owners to build the dispensary in compliance with state marijuana laws, then pass an inspection from the BOP, and finally receive their license. The BOP gives each provisional licensee 270 days to start operating. Previously, there were 58 licensed dispensaries in Ohio, and now, there are nearly 130. That number is only expected to grow in the coming months.

Ohio Gov. Mike DeWine recently signed an executive order banning 7 new opioids due to their dangers of abuse and addiction. The now-banned opioids include butonitazene, etodesnitazene, flunitazene, metonitazene, metodesnitazene, N-pyrrolidino etonitazene, and protonitazene. According to the Ohio Board of Pharmacy, each of the 7 drugs is illegally manufactured, usually in other countries. The Board of Pharmacy supports Gov. DeWine’s executive order and is hopeful that the order will make an impact on Ohio’s ongoing opioid crisis.

The State of Ohio has made big strides in reforming the Medicaid managed care system. Most recently, Ohio Gov. Mike DeWine authorized a single PBM, Gainwell Technologies, to administer the pharmacy benefit to all pharmacies across the state. The decision will set a transparent benchmark for the PBM and initiate an adequate professional dispensing fee. The new single PBM model will be implemented on July 1, 2022.

The Ohio Board of Pharmacy recently passed a new rule, Ohio Admin. Code 4729:5-3-20, that allows pharmacies to start new pilot programs. Under the rule, pharmacies can petition the Board for approval of new projects not currently permitted by Ohio law. Some restrictions apply. For instance, the rule cannot expand the definition of “practice of pharmacy.” In other words, the Board has the power to decide what programs fit within “the practice of pharmacy.” Even with these restrictions, the rule still opens up new avenues not otherwise permitted to pharmacists.

A federal jury ruled in the state of Ohio last Tuesday, finding three of the nation's largest pharmacy chains liable in the opioid epidemic. Walgreens, CVS, and Walmart were found guilty of fueling the opioid crisis in Ohio due to their lack of efforts to prevent pain pills from getting into the wrong hands. The chains strongly disagree with the verdict and claim that it is the doctors' duty to responsibly prescribe these drugs. However, the court stated that pharmacies are the last line of defense against the epidemic, and that these chains did not have enough systems in place, nor the right amount of staff, to catch suspicious activity. This ruling in Ohio now opens the door to similar cases going on in other states.

Centene, the country's largest Medicaid managed-care organization (MCO), is no longer going to be operating as a pharmacy benefit manager (PBM) following an Ohio lawsuit. In March, Ohio Attorney General Dave Yost sued Centene for layering its MCO operations along with PBM operations, resulting in overbilling taxpayers by tens of millions of dollars. While Centene would not admit to any wrongdoing, it has agreed to pay the state of Ohio $88 million for damages. The company has also set aside $1 billion to deal with future similar lawsuits from other states.

A civil trial has begun in the state of Ohio in regards to the opioid crisis. Chain pharmacies such as CVS, Walgreens, and Walmart are being sued in federal court over their role in perpetuating the opioid epidemic. They are being sued for their reckless dispensing of pain medications and ignoring the red flags of patient addiction. If the companies lose the trial, they could be expected to pay billions of dollars to compensate their damage to the victims, as well as government entities and taxpayers who have footed the bill in response to the crisis.

Ohio House Bill 6 was passed by Governor DeWine, implementing several provisions related to the pandemic. Notable elements include: written consent for vaccination of a minor, pharmacists and technicians being able to administer flu, COVID, and other vaccines to children, and other pharmacy technician practice expansions.