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Ohio, OptumRx dispute whether settlement reached


Ohio Attorney General Dave Yost on Tuesday announced a settlement with OptumRx that calls for the pharmacy benefits manager to repay the state $15 million in prescription drug overcharges assessed to the Ohio Bureau of Workers’ Compensation.

Yet a spokesman for the Irvine, California-based company, which disputes the allegations, said a settlement had not been reached.

“We continue to dispute his allegations and are honored to have delivered access to more affordable prescription medications for the Ohio Bureau of Workers’ Compensation and Ohio taxpayers,” the spokesman wrote in an e-mail to Business Insurance.

Mr. Yost’s office has not responded to requests for comment.

The state’s lawsuit against OptumRx alleges the company overcharged the bureau $15.8 million between 2015 and 2018; it asserts that the company failed to manage the costs of generic medications in accordance with contractually agreed-upon discounts for injured workers.

In November 2019, the state filed an amended complaint alleging that OptumRx breached its contract by applying an incorrect reimbursement rate to certain claims for generic drugs and failing to achieve a target reimbursement rate for certain pharmacy claims during a two-year contract extension.