CVS Caremark
Policing prescription-drug middlemen’s middlemen
The Federal Trade Commission on Wednesday announced that it had added massive, new drug-purchasers to an investigation into the practices of powerful drug middlemen. Critics have described those businesses, created since 2019, as another layer of opacity in the already obscure world of drug pricing. The FTC — the federal agency tasked with policing monopolistic […]
Report: “Specialty” drugs are by far the most expensive, but classification seems arbitrary
The prescriptions with the most eye-popping price tags — like cancer meds that can cost more than $20,000 a month — are usually classified as “specialty” drugs. You’d think that since they’re so costly, there would be clear criteria for putting drugs in the specialty category. But, according to a new report, you’d be wrong. […]
Ohio AG files antitrust suit against Express Scripts, Humana, others
In a development that is likely shaking the world of health insurance, Ohio Attorney General Dave Yost on Monday sued six corporate entities over the way they facilitate drug transactions. Yost filed the suit under the Valentine Act — Ohio’s antitrust law — accusing the companies of improperly colluding to fix prices and other actions […]
Health care giant pays Iowa $44M to settle fraud claims with Iowa
The nation’s largest Medicaid managed-care company last week agreed to pay Iowa $44.4 million to settle claims that it defrauded the state’s Medicaid system. That makes it the latest state to settle claims that were originally raised in Ohio in 2021. St. Louis-based Centene agreed to pay the money over claims that its subsidiary, Iowa […]
Pharmacy middleman agrees to pay Ohio Workers’ Comp $15M, attorney general says
OptumRx, a huge pharmacy middleman, has agreed to pay the Ohio Bureau of Workers Compensation $15 million to settle claims that it overbilled the system between 2015 and 2018, Attorney General Dave Yost announced Tuesday.
11th state settles with Medicaid contractor over conduct first uncovered in Ohio
Centene, the largest Medicaid contractor in the United States, has settled with an 11th state over conduct that was initially detected in Ohio. On Aug. 24, a deal was announced between Washington Attorney General Bob Ferguson and St. Louis-based Centene to settle claims that Centene’s pharmacy benefit manager had overbilled the state’s Medicaid system, Reuters […]
Attorney General seeks financial info from Medicaid contractors
In the past month, Ohio Attorney General Dave Yost has sought financial information from the state’s five managed-care contractors, documents received in response to an open-records request show. The AG won’t discuss ongoing investigations, but he might be looking into whether some practices by subcontractors who manage pharmacy benefits violate state law or federal regulations. […]
State employee pension fund to audit big PBM
The upcoming audit will be the fifth time in 10 years that the pharmacy benefit manager to the Ohio Employees Retirement System has been audited. An earlier version of this story said it had been audited more frequently. It’s been updated. The Ohio Employees Retirement System is seeking proposals for a firm to audit Express […]
With big Medicaid changes looming, Ohio pharmacists complain of a lack of details
The Ohio Department of Medicaid plans to radically change the way it does business in July, but a group that helped motivate the reform effort says it hasn't provided some fundamental details. Some members of that group, the state's community pharmacists, say those details could determine whether they can stay in business — and whether some small towns become pharmacy deserts.
After Ohio scandal, Medicaid managed-care giant to exit the pharmacy business
Centene, the nation’s largest Medicaid managed-care company, is planning to stop its work as a pharmacy middleman, or pharmacy benefit manager. Executives last week said the company is issuing a $30 billion request for proposals from an outside contractor to take over the work. The news comes after Ohio Attorney General Dave Yost sued the […]
How info likely leading to massive settlement almost stayed hidden
It seems to be an object lesson in the importance of government transparency. Revelations that quite possibly led to a lawsuit and a billion-dollar settlement by the nation’s largest Medicaid managed-care provider almost never came to light, according to court documents filed last month. Meanwhile, huge drug middlemen are fighting to keep sealed damning information […]
Drug-pricing practice could be banned to help pay for infrastructure bill
Drug-pricing practice could be banned to help pay for infrastructure bill.