CVS
Another state settles Medicaid fraud allegations with Centene
Oregon on Tuesday became the latest state to settle fraud claims with a Medicaid managed-care giant. Litigation in such matters began in Ohio in 2021. St. Louis-based Centene, the largest Medicaid managed-care provider in the United States, agreed to pay Oregon $17 million, according to a statement from the state’s attorney general and its insurance […]
Health care giant confirms $15M settlement — two days after denying it
A prescription middleman on Friday confirmed that it has promised to pay Ohio $15 million to settle fraud claims against it. When the state announced the deal two days earlier, the company denied it had been finalized. Ohio Attorney General Dave Yost on Wednesday announced that pharmacy benefit manager OptumRx had agreed to pay $15 […]
Antitrust regulator takes aim at drug middlemen
The newest member of the Federal Trade Commission last week said that for decades his agency hasn’t served the historical mission of the agency — fairness. And in decrying the rise of megacorporations that dominate vast ranges of services in some economic sectors, he cited pharmacy middlemen as exhibit A. Alvaro Bedoya in May was […]
Basketball billionaire enters the no-insurance, no-middleman drug business
Mark Cuban, owner of the Dallas Mavericks, is getting into a business pioneered by independent pharmacists in Ohio and elsewhere. The idea is to radically reduce consumer costs for common generic drugs by cutting out insurance companies and the middlemen they hire to handle transactions with manufacturers and pharmacies. On Jan. 19, the Mark Cuban […]
Insurers slam critical drug-pricing research but can’t vouch for their own
A spokeswoman for a major health-insurance industry group on Wednesday questioned research cited in a story published Tuesday in the Capital Journal. In doing so, she cited a bit of purported research that she couldn’t vouch for herself. The story was about research showing that insurers working with Medicare are supposed to be lowering care […]
For one drug at least, biggest insurers force Medicare patients to buy the most expensive
In theory, the point of managed care is to save money by negotiating with providers for lower prices. So it would seem that the biggest managed-care providers would use their clout to negotiate the lowest prices from doctors and hospitals and for medicine. But for at least one drug, the largest Medicare managed-care companies are […]
Big questions remain in huge Medicaid procurement
A Franklin County judge earlier this month dismissed a lawsuit over the largest public procurement in Ohio history. But important questions remain about potential corruption and conflicts of interest among key players who had a say in how the contracts were awarded. It’s unclear whether those questions will be answered. In April, the Ohio Department […]
Congressional group takes up PBMs, strikes a partisan tone
Members of Congress last week took up an issue potentially of great importance: What to do about powerful health conglomerates who play an increasingly powerful role in the drug-supply chain. But the event also demonstrated the harsh partisanship that increasingly paralyzes Congress in the face of difficult problems. Rep. James Comer, R-Ky, called the forum […]
U.S. Supreme Court to hear HIV case with implications for Ohio, elsewhere
It’s a practice that’s already been called anti-competitive. Now the U.S. Supreme Court could rule on whether it discriminates against the disabled. The court last week agreed to review a case focused on whether actions of insurers and pharmacy middlemen discriminate against people with HIV, the virus that causes AIDS. The case is on appeal […]
Additional corporations reported to be facing states’ drug-middleman probes
More states are investigating more companies regarding their conduct in the multi-billion dollar business of managing drug transactions, the Wall Street Journal reported Tuesday. The reporting comes after the Capital Journal in April reported that attorneys general in Ohio, Kansas, Mississippi and Arkansas were investigating health care giant Centene. Ohio Attorney General Dave Yost has […]
Conflicting corporate claims at the heart of Ohio’s blockbuster Medicaid suit
Two mega-corporations appear to be claiming they did the same work for Medicaid — Ohio’s $24 billion-a-year program that provides health care to the poorest 25% of state residents. Since the companies received at least $53 million for the work in 2017 alone, the conflicting claims could be a big problem — one with potential […]
State health leaders appeal to Congress for more vaccines, better communication, increased funding
WASHINGTON — State health officials in Colorado, Louisiana and Michigan had a clear answer when asked Tuesday what they need to better vaccinate their residents: more doses, more information to guide their planning, and more money to pay for the mammoth undertaking. That guidance from state leaders came during a U.S. House Energy and Commerce […]