Yost seeking to recover nearly $16M in prescription overcharges

COLUMBUS — Ohio Attorney General Dave Yost Tuesday initiated an effort to recover overcharges to the state for the cost of prescription drugs negotiated by pharmacy benefit managers, beginning the process to collect nearly $16 million on behalf of the Bureau of Workers’ Compensation.

Pharmacy benefit managers are private companies that contract with state agencies such as the Bureau of Workers’ Compensation and Medicaid to manage drug prescriptions for clients of the agencies.

On behalf of the Ohio Bureau of Workers’ Compensation, Yost advised OptumRx that BWC and the state of Ohio intend to file a demand for mediation of disputes with the American Arbitration Association. The mediation is to address $15.8 million in overcharges to the fund intended to protect injured workers. Yost alleges the overcharges occurred because OptumRx failed to provide contractually agreed discounts on drugs.

“BWC’s contract with OptumRx requires us to mediate any disputes before bringing litigation,” Yost said. “I hope that OptumRx will refund these overcharges. I am investigating PBM practices on behalf of a number of state clients and will not hesitate to pursue overcharges and fraudulent conduct. This is an important first step in this process.”

The action comes as Yost and Gov. Mike DeWine review pharmacy benefit manager practices to determine if the state was overcharged for drugs purchased on behalf of state agencies. Yost has hired outside counsel and experts to evaluate pharmacy benefit manager data and pursue litigation if necessary.

In a letter seeking mediation, Yost charges that OptumRx overcharged BWC for generic drugs purchased between Jan. 1, 2015 and Oct. 27, 2018.

The BWC’s contract with OptumRx expired in October, and BWC has contracted with a different pharmacy benefit manager. Pharmacy benefit manager practices in Ohio and other state have been under scrutiny after revelations that some managers have been charging states more for drug prescriptions than the managers were paying pharmacists to fill the prescriptions.

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