OptumRx

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 […]

After Ohio scandal, Medicaid managed-care giant to exit the pharmacy business

BY: - November 2, 2021

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 […]

Medicaid chief stresses transparency, won’t talk about her investments in giant contractors

BY: - October 29, 2021

Medicaid chief stresses transparency, won't talk about her investments in giant contractors.

Firm that facilitated $22B in contracts won’t say if any went to its clients

BY: - October 26, 2021

When the Ohio Department of Medicaid this year selected six companies to manage $22 billion worth of managed-care business, it was supposed to be a competitive process. But some pretty big questions linger about how competitive it actually was.  Somehow, an Ohio-based company was dinged because it hadn’t worked outside the Buckeye State. But giant, […]

In court, drug middlemen fight to limit pharmacies insured patients can use

BY: - September 7, 2021

In the first test of a 2020 U.S. Supreme Court ruling, drug middlemen last week argued that federal law gives them a crucial right to limit what pharmacies patients with health insurance can use — or at least make it more expensive if patients get their medicine at a shop that isn’t preferred by the […]

How info likely leading to massive settlement almost stayed hidden

BY: - August 31, 2021

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

BY: - July 29, 2021

Drug-pricing practice could be banned to help pay for infrastructure bill.

Ohio AG signs on to important pharmacy middleman case

BY: - July 20, 2021

Ohio Attorney General Dave Yost has joined a lawsuit testing states’ power to regulate powerful middlemen who control the way prescription drugs are managed. Yost last week notified the 8th U.S. Court of Appeals in St. Louis that Ohio was joining 30 other states who are urging the court to uphold North Dakota laws meant […]