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 Ohio Attorney General Dave Yost's lawsuit followed a probe into the
extent pharmacy benefit managers (PBMs) like OptumRx had engaged in
pricing practices that resulted in the state overpaying for drugs
for people covered by state health programs.
The probe, begun under Gov. Mike DeWine before he left his position
of attorney general earlier this year, came amid public concerns
about skyrocketing drug prices and the role that PBMs as pharmacy
middlemen play in contributing to the costs.
Yost accused OptumRx of failing for nearly three years to provide
agreed-upon discounts for generic drugs purchased by injured workers
submitting claims to the Ohio Bureau of Workers' Compensation.
"Our review of PBM practices throughout state government is still
ongoing," Yost said in a statement. "These are the first raindrops,
but there's a storm a-comin'."
The lawsuit, filed on Friday in Franklin County Court of Common
Pleas, seeks at least $15 million in compensatory damages and $15
million in punitive damages.
OptumRx did not immediately respond to a request for comment. It has
previously said the state's overcharging claims are "without merit."
PBMs negotiate drug prices for employers and health plans. They
typically demand steep discounts off the drugmakers' list prices for
medicines in exchange for including their products on the PBMs'
preferred formularies, or lists of drugs approved for reimbursement.
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In Ohio, the Bureau of Workers' Compensation and the state's
Medicaid program contract with PBMs to manage drug prescriptions for
the agencies' clients.
Yost, who was elected attorney general in November, previously
served as the state's auditor.
In that role, he released a report in August that found PBMs had
charged the state's Medicaid program an average "spread" of 31
percent for generic drugs, billing $208 million more from April 2017
through March 2018 than it cost to reimburse pharmacies.
OptumRx is the PBM for one of Ohio's five Medicaid managed-care
plans. CVS Health's CVS Caremark unit acts as the PBM for the other
four. The two companies administer $2.5 billion in annual Medicaid
drug spending for Ohio.
OptumRx had also contracted with the workers' compensation agency.
But last year, the agency announced it had hired another company to
manage its pharmaceutical program for injured workers amid claims
OptumRx overcharged it.
(Reporting by Nate Raymond in Boston; Editing by Bill Berkrot)
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