"The spread pricing can get
complicated when reporting rebates and also around the pricing benchmark for
generic drugs. I think [CMS’s] goal is to see a little more transparency on
it….It kind of goes back to, am I making money from other relationships? You
can certainly see their concern over it."
— Ashraf
Shehata, a principal in KPMG's health care life sciences advisory practice and
the firm's Global Healthcare Center of Excellence, spoke with AIS's RADAR on Drug Benefits
about measures CMS has taken to keep so-called 'spread-pricing' — the
difference between what health plans pay PBMs and what PBMs reimburse to
pharmacies — out of Medicaid.
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