State accuses PBM of $16M in overcharges
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The Ohio attorney general says the state will demand a mediation of disputes regarding nearly $16 million in alleged overcharges of prescription drugs negotiated by pharmacy benefit manager OptumRx.
According to Attorney General Dave Yost’s office, OptumRx Inc., based in Irvine, California, was one of the PBMs that contracted with the state’s Bureau of Workers Compensation to manage drug prescriptions for agency clients. The bureau and OptumRx have a contract requiring the mediation of any disputes with the American Arbitration Association before going to litigation. Mr. Yost’s office says its mediation demand is to address the alleged nearly $16 million in overcharges to the state’s workers comp fund for generic drugs purchased between Jan. 1, 2015, and Oct. 27, 2018. The bureau’s contract with OptumRx expired in October.
“I hope that OptumRx will refund these overcharges,” Mr. Yost said in a release. “I am investigating PBM practices on behalf of a number of state clients and will not hesitate to pursue overcharges and fraudulent conduct. This is an important first step in this process.”
The Ohio attorney general’s office and Gov. Mike DeWine have been reviewing PBM practices to determine whether the state of Ohio was overcharged for drugs purchased for injured workers or Medicare beneficiaries. Mr. Yost has retained outside counsel to evaluate PBM data.
OptumRx did not respond to a request for comment.
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