AG Dave Yost says PBM overcharging Ohio will repay $15M. OptumRX denies it

Ohio Attorney General Dave Yost announced Tuesday that UnitedHealth Group-owned OptumRX, one of the largest pharmacy benefit managers in the nation, will repay the state $15 million under a settlement.

"Another shoe has dropped,” Yost said in a statement. “This is another win for Ohio – time for OptumRx to pay up.”

But OptumRX denied any such agreement happening.

"We have not reached a final agreement with the Ohio Attorney General. We continue to dispute his allegations and are honored to have delivered access to more affordable prescription medications for the Ohio Bureau of Workers’ Compensation and Ohio taxpayers,” said Andrew Krejci, spokesperson for the company.

Yost's office, however, maintains a deal was reached.

“We were surprised to see a statement from OptumRx saying that they thought we didn’t have a deal. An agreement was reached. We are in conversations with OptumRx today to determine why they are trying to back out," said Bethany McCorkle, spokesperson for the attorney general.

What is a PBM or a pharmacy benefit manager?

A pharmacy benefit manager plays an important role in how much you are paying for prescription drugs. The company acts as a middleman negotiating for lower prices and discounts with pharmacies and drug manufacturers on behalf of your health plan. It decides which drugs are covered by health plans.

In this case, OptumRX contracted with the Ohio Bureau of Workers Compensation to manage prescription drug costs for the state agency, which provides medical and compensation benefits for work-related injuries, diseases and deaths. Ohio BWC is funded by employers' contributions, taken out from workers' paychecks.

More:How Ohio's new single pharmacy benefit manager will affect you

However, pharmacy benefit managers have been accused of overcharging health insurance plans more than what it costs for pharmacists to actually dispense the drugs, pocketing that difference in their pockets. PBMs have denied any wrongdoing.

What is OptumRX accused of?

Yost's office has said it may have uncovered evidence to show that a pharmacy benefit manager knowingly overcharged Ohio BWC.

Among hundreds of thousands of emails obtained from OptumRX as part of the litigation was one that appears to acknowledge that the multibillion-dollar corporation was not following the terms of its contract with the workers' comp bureau, which called for charging the lowest of four potential prices for generic drugs.

More:Ohio Attorney General Dave Yost says email shows OptumRx was overcharging the state – and knew it

OptumRX disputed that the requirement was part of the PBM's agreement with the state.

According to the lawsuit, OptumRx overcharged the bureau on 57% of 2.3 million prescription claims from injured Ohio workers between January 2014 and September 2018.

Other lawsuits over pharmacy benefit pricing

The bureau dropped OptumRX more than two years ago after a consultant determined the PBM was vastly overcharging the state.

The same consultant later discovered that PBMs ‒ including OptumRX ‒ in Ohio's Medicaid program, which pays for health care of the poor and disabled, were charging three to six times the standard rate, enabling them to take home nearly $250 million in a single year.

Yost is also pursuing a court battle against another PBM owned by Cigna, Express Scripts, for overcharging the Ohio Highway Patrol Retirement System. The attorney general also got $88 million from Centene for overcharging the state's Medicaid system.

“I said before that we will do everything in our power to protect Ohioans from PBMs, and we don’t plan to stop at $100 million in recoveries,” Yost said. “Stay tuned.”

Dispatch archives contributed. This story was updated to reflect that OptumRX has denied any settlement having been agreed to.

Titus Wu is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.

This article originally appeared on The Columbus Dispatch: OptumRx to pay Ohio $15 million to settle suit. The PBM denies such