Ohio AG sues Optum to recover $16M in drug overcharges 

Ohio's attorney general is suing Optum. (fotoguy22/Getty)

Ohio’s attorney general has filed suit against Optum, aiming to reclaim nearly $16 million in what he says are drug overpayments.

In the complaint, AG Dave Yost says OptumRx, the company’s pharmacy benefit management arm, overcharged the state’s Bureau of Worker’s Compensation by more than $15.8 million between 2015 and 2018.

OptumRx failed to pass discounts for drugs on to the bureau on multiple occasions, Yost said, leading to the overpayments. Yost had submitted a letter to Optum in late February, seeking to settle the dispute in formal mediation, but he made clear at the time that a lawsuit was on the table if Optum did not comply.

In a statement, Yost said Optum had 30 days to respond to the state’s mediation request, which it failed to do.

“It’s been 30 days, and we only just now have a meeting scheduled to talk,” Yost said. “Time’s up, give us our money.”

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OptumRx said that the state’s allegations are “without merit” in a statement to FierceHealthcare. The PBM is working with state officials and the bureau to resolve the issue, OptumRx said.

“We are honored to have delivered access to more affordable prescription medications for the Ohio Bureau of Workers’ Compensation and Ohio taxpayers,” OptumRx said.

Ohio is one of several states that have put PBMs under the microscope of late, and the state cancelled its PBM contracts in its Medicaid program due to spread pricing. Yost’s office released a report last summer that revealed PBMs raked in nearly $225 million in revenue through the controversial practice, in which a PBM charges the insurer more than a drug cost at the pharmacy counter and then pockets the difference.

Ohio previously contracted with Optum and CVS as PBMs for Medicaid. Other states, such as New York and Pennsylvania, have also scrutinized spread pricing and other PBM tactics.

In his statement, Yost teased that more was to come on the PBM front, as the state’s investigation continues.

“Our review of PBM practices throughout state government remains ongoing,” Yost said. “These are the first raindrops, but there’s a storm a-comin'.”