Ohio attorney general sues second drug middleman

Ohio Attorney General Dave Yost is taking a second pharmacy benefit manager doing business with the state to court.

Yost on Monday announced that his office had filed suit in the Franklin County Court of Common Pleas against St. Louis-based Express Scripts over work the company had done since 2010 on behalf of the Ohio Highway Patrol Retirement System. A press release announcing the suit doesn’t state a dollar amount the state is seeking, but it says that Express Scripts failed to deliver on guaranteed discounts for drugs, misclassified drugs in order to charge higher prices, overcharged for generic drugs and didn’t disclose payments it received in connection with its work for the state agency.

“This particular PBM egregiously charged for services it didn’t deliver,” Yost said in a statement. “Its repeated breaches cost Ohioans millions, and we want our money back.”

Express Scripts didn’t immediately respond to a request for comment Monday afternoon.

Pharmacy benefit managers have come under scrutiny for the lucrative, often behind-the-scenes role they play in prescription drug transactions. 

Operated by huge health care corporations, the PBMs work in the space between entities that pay for care and pharmacies that dispense drugs. The PBMs determine which drugs will be paid for, negotiate rebates with manufacturers and determine how much pharmacies will be reimbursed.

They have been accused of using a lack of transparency in pricing and rebates to take outsized profits. A 2018 analysis of Ohio’s Medicaid program found that two PBMs — CVS Caremark and OptumRx — charged taxpayers a quarter billion dollars more for Medicaid drugs than they paid pharmacists to dispense them.

In 2019, Ohio’s largest Medicaid managed-care provider, Dayton-based CareSource, fired CVS Caremark as its PBM and hired Express Scripts in its place.

CVS Caremark and Express Scripts are the two of the three largest PBMs in the United States. Yost’s office is suing the third — OptumRx — as well. 

 In that case, the state is seeking repayment of $16 million that it says Optum improperly billed the Bureau of Workers Compensation. One of the claims in that case is that the PBM didn’t provide the agency with discounts guaranteed under its contract.

Yost on Monday said he’s not finished with the PBMs.

“It’s no secret that PBMs have been keeping secret their prescription pricing in order to evade public scrutiny and rake in revenue,” Yost added. “I intend to shed light on their business model and bring true transparency to the process —– they need to answer the tough questions and repay what is owed.”