The court battles between pharmacy benefit manager OptumRx and Ohio’s Bureau of Workers Compensation (BWC) are getting even more severe. Ohio’s BWC sued OptumRx for false dealing in 2019; at the beginning of 2020, OptumRx announced that it was suing Ohio’s BWC for the same thing.
OptumRx is owned by insurance company UnitedHealth Group. OptumRx was found guilty of charging Ohio’s Medicaid managed-care plans $26 million more than it should have charged in 2017. OptumRx and CVS Caremark – the other pharmacy benefit manager (PBM) being charged – have fought to keep parts of that court case from being publicly revealed.
Ohio’s BWC spends more than $80 million each year on prescription drugs. Medical professionals use these medicines to treat injured workers. The BWC says that OptumRX charged far more for these drugs than their contract allows. According to the state’s formal complaint from November 2019, OptumRx charged four times the legal maximum rate for the steroid prednisone.
According to OptumRx, Ohio’s BWC unilaterally changed the Ohio Administrative Code rules regarding maximum rates for prescription drugs while they were in the middle of negotiating their contract in 2016. By changing the rules governing PBMs, OptumRx says the state acted in bad faith.
The office of Ohio Attorney General Dave Yost wrote that the BWC does not change those rules – the state’s General Assembly does that. This assertion will likely be central to this ongoing legal battle.
Ohio’s lawsuit would exact a fine onto OptumRx of up to $5,000 for each day that OptumRx was overcharging for medications. Since the contract started more than a decade ago, the total damages could be nearly $20 million.