pharmacy benefit managers
Health care giant Centene settles with another state, California
Medicaid managed-care giant Centene has agreed to pay California $215 million to settle a drug-pricing scandal related to one that was initially detected in Ohio. In a press release last week, California Attorney General Rob Bonta said that two Centene-owned managed-care plans, California Health & Wellness and Health Net, ripped off the state’s Medicaid system, […]
Health care giant pays Iowa $44M to settle fraud claims with Iowa
The nation’s largest Medicaid managed-care company last week agreed to pay Iowa $44.4 million to settle claims that it defrauded the state’s Medicaid system. That makes it the latest state to settle claims that were originally raised in Ohio in 2021. St. Louis-based Centene agreed to pay the money over claims that its subsidiary, Iowa […]
Consumer groups want antitrust probe of hospital suppliers
The middlemen who buy things like medical equipment for hospitals have vastly consolidated their control of the marketplace in recent decades, nine consumer groups are saying. Now the groups want the Federal Trade Commission to mount a formal investigation to see if the companies are stifling competition among medical suppliers, artificially raising costs and unnecessarily […]
Newest federal regulator wants the little guy to be the focus of antitrust enforcement
From groceries to prescriptions to paychecks, the modern American business landscape makes it increasingly difficult for poorer Americans to get what they need to survive, Alvaro Bedoya, the newest member of the Federal Trade Commission, said in an interview late last month. The consequences have taken the form of food and pharmacy "deserts" and in a paucity of jobs that pay a living wage. "I want to focus on the folks at the bottom of the ladder and are trying to move up and not fall off," he said.
Tax-funded care provider in Ohio makes political donations — in Nevada
Medicaid managed-care provider Centene has already gotten in trouble in Ohio. Then on Friday came the news that its tax-funded Ohio subsidiary has been making political contributions 2,200 miles away in Nevada. Kaiser Health News reported that Centene’s Buckeye Health Plan and many other of its state-level Medicaid subsidiaries have each made $10,000 donations to […]
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 […]
With new acquisition, CVS to get bigger and broader, raising concerns
When CVS Health announced last week that it was buying Signify Health for $8 billion, executives with both companies said it will help them to more effectively deliver care. But some observers are concerned that it means CVS and rival UnitedHealth Group are extending their dominance into yet another aspect of American health care. Dallas-based […]
11th state settles with Medicaid contractor over conduct first uncovered in Ohio
Centene, the largest Medicaid contractor in the United States, has settled with an 11th state over conduct that was initially detected in Ohio. On Aug. 24, a deal was announced between Washington Attorney General Bob Ferguson and St. Louis-based Centene to settle claims that Centene’s pharmacy benefit manager had overbilled the state’s Medicaid system, Reuters […]
Diabetes activists applaud drug reforms, say more needs to be done
Pricing reforms under a sweeping law signed on Tuesday by President Joe Biden are great for diabetics, but much more needs to be done, an activist said Wednesday. As part of the Inflation Reduction Act, monthly out-of-pocket insulin costs for Medicare recipients were capped by the law at $35 a month. Together with capping all […]
Experts: Dems’ drug measures are good for seniors. But there are downsides
The sweeping Inflation Reduction Act passed by Democrats in the U.S. Senate on Sunday takes on an issue that Americans have been screaming about for years: the high cost of prescription drugs. But while it will bring immediate relief to millions of seniors, several experts have said it may dampen development of new drugs and new uses for existing ones. And, they say, it fails altogether in addressing one of the fundamental drivers of increasing drug costs for all Americans — the massive, non-transparent system of rebates charged by drug middlemen.
As new Medicaid prescription program nears, some Ohio pharmacists are worried
Ohio’s community pharmacists are still worried that the state Medicaid program might drive them out of business — and deprive some communities of access to medicine. After years of complaints about under-payment and possible profiteering off of prescription drugs, the legislature in 2019 directed the Department of Medicaid to undertake a bold reform. Instead of […]