OptumRx

Reports: Drug manufacturers and middlemen both responsible for rising consumer costs

BY: - May 17, 2021

The world of prescription drug pricing can be bewildering — intentionally so, some critics of the industry claim.  Whether that’s true or not, several reports this year show that the supply chain’s alchemy of list prices, rebates and net prices hurts consumers. And a U.S. Senate report says drugmakers and middlemen share the blame. The […]

Additional corporations reported to be facing states’ drug-middleman probes

BY: - May 12, 2021

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 […]

Federal probe of drug middlemen urged

BY: - May 10, 2021

After years of accusations in Ohio and elsewhere, a bipartisan group in the U.S. Senate wants federal regulators to investigate whether drug middlemen and their parent companies are rigging the system to raise prices and pad their pockets. Sens. Chuck Grassley, R-Iowa, and Maria Cantwell, D-Wash., last month filed legislation that would require the federal […]

Ohio hires Medicaid prescription drug watchdog

BY: - April 15, 2021

As it makes sweeping reforms to the way it handles managed care for the state’s $24 billion Medicaid program, Ohio on Wednesday announced that it had hired a company to monitor its progress.  The Department of Medicaid announced that it had hired the Medicaid and Medicare auditing firm Myers and Stauffer to be its pharmacy […]

Ohio suit against health care giant is sealed. Here’s why

BY: - March 16, 2021

Ohio Attorney General Dave Yost last week filed suit against the largest Medicaid managed-care provider in the United States.  The suit appears to accuse St. Louis-based Centene of improper billing, misrepresentation of its costs and other offenses. But it’s impossible to know for sure because the case was filed under seal. For the most part, […]

Will state Medicaid reforms prove we were getting a bad deal?

BY: - March 15, 2021

The Ohio Department of Medicaid in January implemented a massive overhaul to the way it administers prescription drug benefits to more than a quarter of all Ohioans. Now, the department is hiring its own middleman to handle the transactions. The department expects to save $128 million during the fiscal year starting July 1 and $184 […]

Ohio sues health giant over drug discrepancies

BY: - March 12, 2021

Ohio Attorney General Dave Yost has sued the largest Medicaid provider in the U.S. He’s claiming that, in addition to other transgressions, health care giant Centene billed the Ohio Department of Medicaid’s pharmacy program for money that had already been paid. The St. Louis-based company owns the Buckeye Health Plan, one of the five managed-care […]

Professional groups announce drug-accountability effort

BY: - December 21, 2020

A dozen Ohio professional groups on Monday announced an effort force greater accountability from powerful prescription drug middlemen known as pharmacy benefit managers, or PBMs. The PBM Accountability Project of Ohio is intended to educate policymakers and the public about problems involving PBMs and work on policies to address them. “Lawmakers and administration officials in […]

State suit against drug middlemen delayed

BY: - December 4, 2020

Ohio’s first lawsuit against middlemen accused of overcharging state agencies for prescription drugs has again been delayed.  Originally slated for trial last March, the Bureau of Workers’ Compensation case against OptumRx now is scheduled to be heard on Nov. 1, 2021. In it, the state says Optum overcharged the agency between 2015 and 2019 by […]

Big fight over drug pricing heads to the Supreme Court

BY: - October 5, 2020

A years-long fight over whether states have the authority to regulate important aspects of drug pricing will be argued before the U.S. Supreme Court Tuesday morning.

Are companies being sued by Ohio also bidding on new Medicaid contract?

BY: - August 19, 2020

The Ohio Department Medicaid won't say whether it will award a big contract to companies against whom the state has filed lawsuits claiming the companies ripped off state agencies in transactions involving prescription drugs.

Feds said to be investigating largest Medicaid provider in the U.S.

BY: - July 20, 2020

Federal officials are probing actions taken in Ohio in 2017 by the largest Medicaid managed care provider in the United States, a source familiar with the investigation has told Ohio Capital Journal.  The U.S. Centers for Medicaid and Medicare Services declined to confirm or deny the existence of an investigation. But the source said the […]