Centene to pay $13.7M to settle PBM allegations in New Mexico

Centene will pay $13.7 million to settle more pharmacy benefit management overpayment allegations in Medicaid, this time in New Mexico.

New Mexico Attorney General Hector Balderas' investigation (PDF) focused on concerns that Centene was layering fees and thus not passing discounts on to Centennial Care, the state's Medicaid program. Centene's PBM subsidiaries have serviced Centennial Care members since 2019.

As part of the settlement, Centene agrees to provide complete price transparency on pharmaceutical benefits and services provided to the state.

“Vulnerable New Mexicans should not have to worry about paying surging prescription drug costs,” said Balderas in a statement. “This investigation was necessary to shine a light on industry practices, ensure greater accountability and return $13.7 million back to New Mexico."

The insurer set aside $1.1 billion to address a series of similar allegations in multiple states, with the settlement in New Mexico the sixth such arrangement in the string of cases.

The settlements include $56 million in two installments to Illinois and $15.2 million to Arkansas. Centene will also pay more than $27 million to settle PBM allegations in Kansas.

In addition to the settlement with Centene, Balderas' office said it will investigate other PBMs operating in the state's Medicaid program following the Federal Trade Commission's decision last week to investigate the industry's largest companies.