Yost files additional charges against OptumRx for prescription overcharges

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COLUMBUS – Ohio Attorney General Dave 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,” Yost said.

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. 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.

The original lawsuit filed in March claimed the pharmacy benefit manager (PBM) overcharged the Ohio Bureau of Workers’ Compensation (BWC) nearly $16 million for generic drugs purchased between Jan. 1, 2015 and Oct. 27, 2018.

PBMs are private companies that contract with state agencies such as the BWC and Medicaid to manage drug prescriptions for clients of the agencies.

Yost alleges “BWC was regularly charged commercially unreasonable prices for generic drugs.”

The complaint states, “during the fourth quarter of 2016, OptumRx’s average charge to BWC for Celecoxib 200 mg capsules, which had been available in the marketplace as a multiple-source generic since late 2014, was more than 200 percent of the Federal Upper Limit and more than 300 percent of the National Average Drug Acquisition Cost, another federal drug-pricing benchmark maintained by the Centers for Medicare and Medicaid Services.”

The BWC’s contract with OptumRx expired in October of 2018, and BWC has contracted with a different PBM. 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.

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