“We’ll see you in court:” State expands lawsuit against pharmacy benefit manager in BWC contract dispute over generic drug prices

After months of unsuccessful mediation, Ohio Attorney General Dave Yost filed an amended complaint in the Franklin County Court of Common Pleas against pharmacy benefit manager (PBM), OptumRx.

The complaint, which brings additional claims and damages against Optum, alleges that the PBM regularly overcharged the Bureau of Workers’ Compensation (BWC) by “millions of dollars” with “commercially unreasonable prices for generic drugs.” PBMs like Optum are companies that contract with state agencies, such as the BWC and Medicaid, to manage drug prescriptions. The state alleges that, between January 2015 and October 2018, Optum breached its contract with the BWC by having the state pay for drugs at rates exceeding the standards agreed upon, including the lesser of Optum’s maximum allowable cost price and the Federal Upper Limit and other prices.

“It’s time for the feet-dragging to stop – we’ll see you in court,” AG Yost said in a statement released after filing the amended complaint.

The amended complaint requests $25,000 in compensatory damages and $5,000 per day since Optum’s first alleged breach of the BWC contract, which is “significantly more” than the original complaint’s claim of $16 million in overcharges.

The BWC has since contracted with a different PBM. This comes as Ohio Governor Mike DeWine’s administration and the General Assembly move towards establishing a single PMB contract for Medicaid and while the pricing practices of PBMs are under increased scrutiny by Ohio and other states.