Payer Roundup—Ohio's biggest Medicaid payer ditches CVS for Express Scripts 

Dollar bill with a hole in Washington's face on it and the word "Medicaid" in its place
CareSource, Ohio's largest Medicaid insurer, will now contract with Express Scripts for pharmacy benefit management services, plus more payer headlines. (zimmytws/GettyImages)

Ohio's largest Medicaid insurer ditches CVS for Express Scripts 

Pharmacy benefit managers in Ohio’s Medicaid program have been under fire for using spread pricing to maximize profits, and amid that debate the state’s largest Medicaid insurer is breaking up with CVS to contract with Express Scripts instead. 

CareSource, which provides Medicaid managed care to 1 million Ohioans, said it “saw an opportunity” to rethink its PBM model with a focus on greater transparency. 

CVS Caremark, the healthcare giant’s PBM arm, has been under major scrutiny in the state for its pricing practices. A state report found that in 2017 it earned $200 million through spread pricing in Ohio’s Medicaid program. (The Columbus Dispatch


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Blue Cross Blue Shield of Texas to open primary care clinics 

Blue Cross Blue Shield of Texas announced that it plans to open 10 medical centers by the beginning of next year. 

The facilities will offer primary care, lab testing, urgent care, imaging and wellness services in the Dallas and Houston markets. The insurer says the clinics will help it manage rising healthcare costs. 

Construction is set to begin this spring. 

Blue Cross is the state’s largest insurer, boasting 5 million members. (Dallas Morning News

CMS plans to expand coverage for ambulatory blood pressure monitoring 

The Centers for Medicare & Medicaid Services announced Tuesday that it would update its coverage policy for ambulatory blood pressure monitoring, based on feedback from industry stakeholders. 

ABPM is a diagnostic test that uses a device to monitor patients’ blood pressure in 24-hour windows and may more accurately diagnose hypertension. CMS determined in 2001 that it would be covered by Medicare for beneficiaries who experience “white coat hypertension,” caused by patient anxiety when they visit a doctor. 

Medicare will also now cover ABPM in suspected cases of “masked hypertension,” or when a patient’s blood pressure is higher in the doctor’s office than outside the office, but that may not be solely attributable to anxiety or fear. 

CMS Administrator Seema Verma said the change is supported by “many years of evidence.” (Announcement

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