Centene to pay more than $71M to settle Medicaid overpayment cases in Illinois, Arkansas

Centene
Centene previously settled similar cases in Ohio and Mississippi. (Centene)

Centene Corporation will pay more than $71.2 million to settle allegations from Illinois and Arkansas that a pharmacy benefit manager subsidiary submitted inaccurate bills and failed to disclose discounts.

The insurer will pay out more than $56 million in two installments to Illinois and $15.2 million to Arkansas, attorneys general for both states announced late Thursday.

The government insurance giant already agreed to pay out more than $140 million to settle similar cases in Ohio and Mississippi. Those settlements were reached earlier this year, with $88 million going to Ohio and $55 million to Mississippi to resolve the cases.

Illinois officials alleged that Centene's Envolve subsidiary, as the PBM for the state's Medicaid program, submitted inaccurate reimbursement requests that "failed to accurately disclose the cost of pharmacy services." It also did not note discounts and "improperly inflated" dispensing fees, Illinois said.

RELATED: Ohio AG sues Express Scripts to reclaim drug overcharges

“Pharmacy benefit managers are part of a larger issue, which is the accessibility and affordability of prescription drugs,” Illinois Attorney General Kwame Raoul said in a statement. “No one should have to choose between paying for basic necessities or costly but essential medications. My office is continuing to investigate pharmacy benefit managers operating in Illinois because I am committed to stopping unfair and unlawful conduct by PBMs and drug companies.”

A Centene spokesperson told Fierce Healthcare that they "respect the deep and critically important relationships we have with our state partners."

"This no-fault agreement reflects the significance we place on addressing their concerns and our ongoing commitment to making the delivery of healthcare local, simple and transparent. Importantly, this allows us to continue our relentless focus on delivering high-quality outcomes to our members," the spokesperson said.

In the Arkansas case, state officials said Envolve subcontracted the management of payments to pharmacies to CVS Caremark, and as such failed to disclose discounts and dispensing fees it received under that arrangement.

Arkansas said this behavior occurred in 2017 and 2018 and ended with the contract between Envolve and CVS.

“I have successfully fought predatory pharmacy benefit managers in the nation’s highest Court, and I continue to hold these providers accountable for gouging Arkansans with unreasonably high costs for their prescriptions,” said Arkansas Attorney General Leslie Rutledge in a statement. “I will always fight to protect Arkansans, and this settlement with Centene is a big step in repairing the damage it did by taking advantage of Arkansans.”