Since the state of Ohio commissioned a 2018 report claiming OptumRx, the pharmacy benefit unit of UnitedHealth Group, was overcharging the state's Medicaid programs by millions of dollars, OptumRx and Ohio have been locked in a legal battle.
In response to the claims against OptumRx, Ohio restructured its Medicaid program's pharmacy benefit management and has filed several claims against OptumRx, accusing it of overcharging the state by $16 million.
OptumRx has maintained that the allegations against it are "without merit" and has accused an Ohio agency of false dealing.
A timeline of events in the dispute, as reported by Becker's Hospital Review:
Aug. 8, 2018: OptumRx at center of state report questioning PBM costs
Ohio fights to release a report detailing what it paid OptumRx to manage its Medicaid beneficiaries' prescription drug plans after The Columbus Dispatch published a report outlining how the state was potentially overspending on prescription drugs.
Aug. 15, 2018: Ohio Medicaid terminates contracts with Optum, CVS Caremark
Ohio's Department of Medicaid cancels its contracts with OptumRx and CVS Caremark after finding the two pharmacy benefit managers charged 8.8 percent more than they paid pharmacies to fill prescriptions, allowing them to pocket more than $224 million.
Feb. 19, 2019: Ohio AG seeks $16M repayment from OptumRx
Ohio Attorney General Dave Yost sends a letter to OptumRx, claiming it overcharged Ohio's Bureau of Workers' Compensation by $6 million in 2015, by $2.7 million between the beginning of 2016 and the end of October 2016 and by $7.2 million between Nov. 1, 2016, and Oct. 27, 2018. He asks for mediation between OptumRx and the state to resolve the dispute.
March 18, 2019: Ohio sues OptumRx to recover $16M in overcharges
After mediation fails, Mr. Yost sues OptumRx to recoup the $16 million in alleged overcharges.
July 16, 2019: Ohio shakes up PBM landscape, plans to contract with 1 PBM
Ohio House and Senate leaders agree on a plan to reshape how pharmacy benefit management works in the state Medicaid program. The agreement directs Ohio's Medicaid program to cut out private managed care companies and the pharmacy middleman they hire to manage pharmacy benefits.
Nov. 25, 2019: Ohio adds breach of contract charges to lawsuit against OptumRx
Mr. Yost files an updated complaint against OptumRx, claiming it breached its contract by not fulfilling its obligation to give the state the best available rates. The new court filing claims the worker's compensation bureau "suffered significant financial damages in the form of overpayments for generic drugs dispensed to BWC claimants," and that OptumRx overcharged Ohio so it could offer its other clients lower rates.
Dec. 11, 2019: 1,600 Ohio pharmacies urge state to improve its Medicaid reimbursement
The National Association of Chain Drug Stores urges Ohio's Medicaid director to require pharmacy benefit managers to pay pharmacies at least a drug's value as listed in the National Drug Acquisition Cost list, a market-based data set from the federal government.
Jan. 9, 2020: OptumRX says Ohio didn't play fair in drug-pricing negotiations
OptumRx accuses Ohio's Bureau of Worker's Compensation of false dealing, claiming the agency unilaterally changed the state's administrative code rules during negotiations in 2016.
Feb. 10, 2020: OptumRx overcharged Ohio for over 1M prescriptions, attorney general claims
Ohio Attorney General Dave Yost filed an additional claim against OptumRx, saying it overcharged Ohio's Bureau of Workers' Compensation on more than 1.3 million prescription claims.