OptumRx Overcharged Ohio $16 mm, says State AG

A new case in the Franklin County Common Pleas Court finds Ohio Attorney General Dave Yost suing a company which was supposed to help injured workers receive their pharmacy benefits.

Franklin County, which is where the city of Columbus is located, will hear Yost’s case. Yost is demanding $16 million worth of repayment, based on services that Ohio’s Bureau of Workers’ Compensation had hired OptumRx to provide. After a month of the state pursuing mediation, as their contract called for, Ohio is now looking for OptumRx to repay that $16 million.

OptumRx, which is based in Eden Prairie, Minnesota, has been in existence for the past 29 years. The company manages pharmacy benefits, and specializes in managing prescription drug benefits. For workers in unions or on government health plans, OptumRx may serve as their pharmacy. The company owns and runs a chain of community pharmacies across the country, and also oversees a mail-fulfillment prescription service.

The company, which was called Prescription Solutions, Inc. until 2012, is managed by CEO John Prince.

According to an article in the Columbus Dispatch, Yost claims that OptumRx did not deliver promised discounts on generic drugs. As a result, Yost alleges that OptumRx overcharged Ohio workers to the tune of $16 million. The new lawsuit seeks both punitive and compensatory damages, for a total of $30 million.

Ohio’s Bureau of Workers’ Compensation spends about $86 million each year on prescription drugs. They work with pharmacy benefit managers (PBMs) like OptumRx and CVS Caremark to reduce prices on those drugs. OptumRx and CVS Caremark administer a total of $2.5 billion in Medicaid drug spending, so if this case ends in favor of Ohio, it could open the door for other litigation.