OptumRx has to repay the state $15 million in prescription-drug overcharges assessed to the Ohio Bureau of Workers’ Compensation (BWC) under an agreement announced today by Ohio Attorney General Dave Yost, according to a press release from the Attorney General’s Public Information Officer, Hannah Hundley.
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“Another shoe has dropped,” Yost said. “This is another win for Ohio- time for OptumRx to pay up.”
The Yost administration has now recovered more than $100 million from pharmacy benefit managers (PBM’s), the release said.
Yost filed a lawsuit against OptumRx claiming that the Irvine, California-based company overcharged the BWC $15.8 million from January 1, 2015 through October 27, 2018, Hundley said.
“The complaint asserted that the company failed to manage the costs of generic medications in accordance with contractually agreed-upon discounts,” Hundley said in the release.
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In November 2019, the state filed an amended complaint stating that OptumRx breached its contract, the release said.
“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 by failing to achieve a target reimbursement rate for certain pharmacy claims during the final two-year contract extension,” according to Hundley.
OptumRx denied these allegations, the release said.
“Under the settlement agreement, OptumRx admits no wrongdoing or liability,” as stated in the release.
PBMs are private companies that contract with state agencies to manage prescription-drug costs for clients of those agencies, Hundley said in the release.
There have been many lawsuits regarding PBM’s charging states more for drugs than they paid pharmacists to fill the prescriptions, Hundley said.
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Along with this case, Yost has pursued two other similar cases.
“I said before that we will do everything in our power to protect Ohioans from PBMs, and we don’t plan to stop at $100 million in recoveries,” Yost said, “Stay tuned.”
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