OptumRx is accusing Ohio's Bureau of Worker's Compensation of false dealing, claiming the agency unilaterally changed the state's administrative code rules during negotiation, according to The Columbus Dispatch.
Ohio's attorney general filed an updated lawsuit against OptumRx — the former pharmacy benefit manager for the worker's compensation bureau — in November, claiming the PBM charged the agency for prescription drugs as much as six times the allowed maximum rate in the contract. The bureau spends about $86 million a year to cover prescription drug costs for injured workers.
Optum was previously found to have billed Ohio $26 million more for prescription drugs than it paid to pharmacists over the course of a year, according to the Dispatch. Ohio is seeking a fine of as much as $5,000 per day for each day the inflated prices were charged, which could total in as much as $20 million.
Optum is now claiming the bureau "breached the implied covenant of good faith and fair dealing," according to the Dispatch. The state allegedly did so by "unilaterally" changing Ohio Administrative Code rules, which govern how much PBMs such as Optum pay the bureau for drugs, in the middle of contract negotiations in 2016.
The Dispatch reported that the rules in the administrative code are adopted to enact laws in the Ohio Revised Code, and those laws are passed by the legislature and signed by the governor.
A senior public information officer for Ohio Attorney General Dave Yost told the Dispatch that the worker's compensation bureau "cannot amend the Ohio Revised Code. The General Assembly does that. We are looking forward to moving this case forward."
A spokesperson for Optum told the Dispatch that the PBM won't discuss the specifics of the litigation but that "we believe these allegations are without merit, and will vigorously defend ourselves."
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