Ohio’s AG Yost Tells OptumRx ‘We’ll See You in Court’ for Overbilling the State’s Bureau of Workers Compensation Millions

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Attorney General Dave Yost announced Monday he amended his lawsuit filed against pharmacy benefit manager (PBM) OptumRx, claiming the PBM excessively charged the Ohio Bureau of Workers Compensation for generic drugs. The overcharge totaled nearly $16 million. It is now “significantly more.”

Yost tweeted:

AG Yost has filed an amended complaint bringing additional claims and damages against pharmacy benefit manager OptumRx in Franklin County Common Pleas Court.

‘It’s time for the feet-dragging to stop – we’ll see you in court,’ he said.”

 

The new filing brings additional “claims and damages against pharmacy benefit manager OptumRx in Franklin County Common Pleas Court,” the Attorney General’s office said in a statement.

“The amended complaint expands breach of contract allegations and addresses significantly more than $16 million in overcharges to the fund intended to protect injured workers, adding more detail to overcharges for specific drugs,” the statement explained. “Yost’s office had sent a letter to OptumRx requesting contract-mandated mediation in February. After months of unsuccessful discussions with little to no effort to resolve the claims from OptumRx, the amended lawsuit was filed late Friday afternoon.

State agencies, such as the BWC, contract with private companies to manage the prescription drugs of agency clients. Those companies are called “pharmacy benefit managers” in Ohio law, or PBMs.

Yost said, “BWC was regularly charged commercially unreasonable prices for generic drugs,”

AG Yost filed the suit in the Franklin County Court of Common Pleas. Judge Michael Holbrook is hearing the case.

The complaint revealed OptumRx had formerly been known as SXC Health Solutions, Inc. and contracted with BWC since 2009.

It stated, in part, “Plaintiffs bring claims against OptumRx for breach of contract, including the breach of the covenant of good faith and fair dealing.”

The filing states, “OptumRx failed to comply with these [aforementioned] pricing provisions, and regularly charged BWC amounts for multi-source generic drugs that exceeded the Federal Upper Limit established by CMS which was the ‘lesser of’ pricing available for a particular claim.”

Some of the damages laid out in the lawsuit:

…Plaintiffs have suffered direct economic harm in the form of wrongful overcharges for prescription drugs dispensed to claimants under Ohio’s workers’ compensation system. Plaintiffs seek an award of such damages, upon sufficient proof thereof, as will place them in the same economic position they would have occupied in the absence of any breach of duty by OptumRx.

Because of the difficulty assessing actual costs, “…Plaintiffs rely on the express provisions of the BWC Contract permitting the recovery of stipulated damages in the amount of $5,000 per day, from the first day of a proven breach until the breach is cured, as a basis for recovery and for the calculation of damages.”

The contract with OptumRx expired last October. BWC chose a different PBM with which to work. Yost added, “PBM practices in Ohio and other states have been under intense scrutiny after revelations that some PBMs have been charging states far more for drug prescriptions than the PBMs were paying pharmacists to fill the prescriptions.”

Read the full complaint here.

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Beth Lear is a reporter at The Ohio Star.  Follow Beth on Twitter.  Email tips to [email protected].
Photo “AG David Yost” by the Ohio Attorney General’s Office.

 

 

 

 

 

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