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.
Big PBM decision undergoes its first test
The stakes appear to be pretty high. After a unanimous ruling in a related case in December, the U.S. Supreme Court has reopened a case regarding sweeping regulations of powerful middlemen known as pharmacy benefit managers — and 30 state attorneys general and many others are joining the fray. Pharmacy benefit managers, or PBMs, are […]
Centene agrees to settle Medicaid claims with Ohio, Mississippi for $143 million
In what could be a harbinger of more settlements, Medicaid managed-care contractor Centene on Monday settled potential fraud claims by Ohio and Mississippi for $88.3 million and $55 million, respectively. Ohio is the only state to file suit so far alleging improper double billing through Centene’s pharmacy middlemen. But Mississippi, Kansas, Arkansas, Georgia, Oklahoma and […]
Antitrust concerns are increasing on Capitol Hill. Advocates say they should extend to drug pricing
Antitrust concerns are increasing on Capitol Hill. Advocates say they should extend to drug pricing.
Eleven generic versions of an HIV drug rush onto the market… and list prices go up
The health care system is supposed to incentivize the development of wonder drugs and then apply market forces to squeeze prices to a minimum. But a new report shows how at least for one drug, incentivizing is working a lot better than price-squeezing. At least when insurance is involved. For example, Blueberry Pharmacy in the […]