OptumRx

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 […]

Big PBM decision undergoes its first test

BY: - July 9, 2021

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 […]

U.S. Supreme Court to hear HIV case with implications for Ohio, elsewhere

BY: - July 8, 2021

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 […]

Centene agrees to settle Medicaid claims with Ohio, Mississippi for $143 million

BY: - June 14, 2021

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 […]

Ohio suits against drug middlemen headed for the long haul

BY: - June 7, 2021

Ohio has been one of the most active states litigating against drug middlemen, whom Attorney General Dave Yost accuses of bilking state agencies out of tens of millions of dollars. Other states also have been active in court against the healthcare giants. Notably, Arkansas last year squared off at the U.S. Supreme Court against the […]

Antitrust concerns are increasing on Capitol Hill. Advocates say they should extend to drug pricing

BY: - June 1, 2021

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

BY: - May 28, 2021

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 […]