OptumRx

Deep inside the gun bill: a break for drug middlemen

BY: - June 22, 2022

Many Americans across the political spectrum are clamoring for federal action on guns in the wake of a mass shooting at an Uvalde, Texas, elementary school, a Buffalo, N.Y., grocery store and hundreds of other mass shootings. But buried in a bipartisan compromise hashed out by the U.S. Senate on Tuesday is an unrelated provision they might not be so happy about. Apropos of nothing, the gun bill would enhance the exemption drug middlemen working with Medicare have from the federal "Anti-Kickback Statute." 

After years, pharmacy-middleman suit might finally come to trial

BY: - May 16, 2022

Since at least 2016, Ohio pharmacists have been accusing large companies acting as pharmacy middlemen of abusive practices, which they deny. And since 2019, the state has been accusing them as well, in the form of lawsuits. Now, after years of wrangling in court, some of that litigation might be headed to trial. The middlemen, […]

Louisiana sues health care company over practices under investigation in Ohio

BY: - April 22, 2022

Louisiana is suing health care giant UnitedHealth over several business practices, saying it is seeking “to recover billions of dollars in inflated prescription-drug prices” for the state Medicaid program. Among its allegations, the state accuses the company of gaming federal oversight reports meant to ensure that at least 85% of the money it gets from […]

Attorney General seeks financial info from Medicaid contractors

BY: - March 11, 2022

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

BY: - March 11, 2022

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

BY: - February 3, 2022

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.

Basketball billionaire enters the no-insurance, no-middleman drug business

BY: - February 2, 2022

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 […]

Health companies accused of abuses even as they get giant government contracts

BY: - December 14, 2021

Even though two huge health care companies were accused of abusing Ohio taxpayers in the past, the Ohio Department of Medicaid this year awarded them historic contracts, anyway. Even as that’s happening, another form of abuse might be taking place, critics say. At issue is whether pharmacy middlemen owned by the companies are pocketing huge […]

Insurers slam critical drug-pricing research but can’t vouch for their own

BY: - December 9, 2021

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 […]

Medicaid giant settles with fifth state

BY: - December 8, 2021

Centene, the nation’s largest Medicaid managed-care provider, has settled fraud allegations with a fifth state, Kansas Attorney General Derek Schmidt announced Monday. The $27.6 million Kansas settlement comes after Mississippi, Illinois and Arkansas announced settlements totaling $154 million. All of those follow a settlement with Ohio — the only state to actually sue the company […]

Congressional group takes up PBMs, strikes a partisan tone

BY: - November 26, 2021

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 […]

CVS sometimes forces people to use its pharmacies. Now the Supreme Court will weigh in

BY: - November 5, 2021

It’s a practice long complained of in Ohio. CVS Health and other massive corporations often use their pharmacy middleman subsidiaries to force people to get the most expensive class of drugs from the businesses’ own mail-order pharmacies. Some call the practice “patient steering.” CVS and companies such as UnitedHealth and ExpressScripts/Cigna say the arrangements save […]