Ohio wins $88M settlement from prescription drug manager
(The Center Square) – A nearly three-year investigation that began when Ohio Attorney General Dave Yost was the state auditor led to a nearly $90 million settlement with one of the state’s largest medical insurers over Medicaid billing.
Centene Corp. agreed to pay Ohio $88.3 million to settle the lawsuit, which claimed the pharmacy benefit manager overbilled the Ohio Department of Medicaid for pharmacy services it provided. Yost claimed Centene and its subsidiary, Buckeye Health Plan, conspired to misrepresent the costs of pharmacy services, including the cost of prescription drugs.
The Department of Medicaid administers a taxpayer-funded medical assistance plan that covers nearly 2.9 million Ohioans through the use of managed care organizations.
The settlement was the first and largest in the country secured by a state attorney general against a pharmacy benefit manager. The company also settled with Mississippi for $55 million, according to a report by Georgia Health News.
“Centene used sophisticated moves to bill unearned dollars – moves known only at the top levels of health care companies,” Yost said. “It has taken a huge effort by my team to untangle this scheme – and now that we know how it works, the alarm bells should be ringing for anyone using similar tactics.”
Yost said most Ohioans’ prescription-drug plans are under the management of a pharmacy benefit manager through their health insurance plans. PBMs, he said, are middlemen in control of prescription drug costs, and they decide which prescriptions are covered by insurance.
Yost started investigating PBMs as state auditor in 2018 and said he found they collected more for drugs compared with the actual cost to dispense the drugs.
“Centene took advantage of all of us who pay taxes to care for the most vulnerable Ohioans,” Yost said. “This settlement is the big first step Centene is taking to repair Ohio’s trust, and it’s my hope they continue on this path of good faith.”
Centene issued a statement regarding the settlements in Ohio and Mississippi.
“We respect the deep and critically important relationships we have with our state partners,” said Brent Layton, Centene’s president of health plans, markets and products. “These agreements reflect the significance we place on addressing their concerns and our ongoing commitment to making the delivery of health care local, simple and transparent. Importantly, putting these issues behind us allows us to continue our relentless focus on delivering high-quality outcomes to our members.”
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