OptumRx Responds to Overcharge Lawsuit

Friday, January 10, 2020 | 0

Pharmacy benefits manager OptumRx has fired back against a lawsuit filed by the Ohio attorney general that claims the company overcharged the state-run workers' compensation system for prescription drugs.

In a response to the lawsuit, OptumRx argues that Ohio officials breached the “covenant of good faith and fair dealing” by changing the rules on how much PBMs paid the Bureau of Workers' Compensation. The rules were unilaterally changed in the middle of contract negotiations in 2016, the company said, according to an Ohio news report.

But Ohio Attorney General Dave Yost's office said the argument is without merit and that the rules had to be changed because legislation required it.

“The BWC cannot amend the Ohio Revised Code,” Dave O’Neill, senior public information officer for Yost, told the newspaper. “The General Assembly does that. We are looking forward to moving this case forward.”

Yost has charged that Optum breached its contract by failing to find the lowest prices on prescription drugs for injured workers and Medicaid recipients. In one example, the state's lawsuit alleges that Optum charged the BWC for prednisone at four times the rate that was allowed under the contract.

The bureau signed a new contract with another PBM in 2019. But the lawsuit alleges that Optum owes the state millions of dollars. Ohio is seeking fines of up to $5,000 per day for each day that improper prices were charged to the state agencies.

Optum officials have said that the suit is without merit and that the company did not violate the contract.