(COLUMBUS, Ohio) — Ohio Attorney General Dave Yost filed a lawsuit in Franklin County Common Pleas Court against OptumRX, taking the next step in an effort to recover overcharges to the state for the cost of prescription drugs negotiated by pharmacy benefit managers (PBMs).
The attorney general’s office informed OptumRx on Monday, Feb. 11, that the Ohio Bureau of Workers’ Compensation (BWC) and the State of Ohio were filing a demand for mediation of disputes. OptumRx had 30 days to respond to the mediation request. That 30-day clock ran out.
“It’s been 30 days and we only just now have a meeting scheduled to talk,” Yost said. “Times up, give us our money.”
PBMs are private companies that contract with state agencies such as the BWC and Medicaid to manage drug prescriptions for clients of the agencies.
The lawsuit addresses the nearly $16 million in overcharges to the fund intended to protect injured workers. Yost alleges that the overcharges occurred because OptumRx failed to provide contractually agreed discounts on drugs.
“Our review of PBM practices throughout state government is still ongoing,” Yost said. “These are the first raindrops, but there’s a storm a-comin’.”
This investigation started under then-Attorney General and current Gov. Mike DeWine and would not be possible without his cooperation.
Yost has charged that OptumRx overcharged BWC for generic drugs purchased between Jan. 1, 2015, and Oct. 27, 2018, which total $15,843,112. Per BWC’s contract, an arbitration demand letter was issued to the American Arbitration Association.
The BWC’s contract with OptumRx expired in October, and BWC has contracted with a different PBM. PBM practices in Ohio and other states have been under intense scrutiny after revelations that some PBMs have been charging states far more for drug prescriptions than the PBMs were paying pharmacists to fill the prescriptions.
Click here to see the full complaint. An accessible version of the complaint is available by request.