A lawsuit filed by a major pharmacy benefit manager in December alleges the Mississippi Board of Pharmacy violated the company’s right to due process by releasing the findings of an audit before determining any wrongdoing.
The audit’s findings, released by the Board of Pharmacy in October, indicate that OptumRx may have violated Mississippi law by paying independent pharmacies in Mississippi rates lower than chains and Optum-affiliated pharmacies for the same prescription drugs in 2022.
Mississippi law prohibits pharmacy benefit managers from reimbursing their affiliate pharmacies, or those they own, at higher rates than non-affiliate pharmacies for the same services.
OptumRx filed the complaint in Hinds County Chancery Court on Dec. 10, naming all seven Board of Pharmacy members and Executive Director Susan McCoy as defendants. The lawsuit asks the judge to rule that an independent hearing officer preside over the administrative hearing on the audit’s findings.
Administrative hearings can lead to disciplinary action by the Board of Pharmacy, including fines.
A “one-sided press release” issued by the Board of Pharmacy – a two-page document summarizing the 848-page audit completed by Ridgeland-based HORNE accounting firm – thwarted OptumRx’s right to a fair and impartial hearing and demonstrated the board’s bias against the company, said the lawsuit.
The press release did not note the company’s upcoming administrative hearing to determine whether it had violated Mississippi law or state that OptumRx disputes the board’s claims.
An administrative hearing on the alleged law violations was previously scheduled for Dec. 19 but has been delayed due to the lawsuit.
The board declined to provide an independent hearing officer to oversee the administrative proceedings or to remove the press release from their website. It said it would “entertain” the possibility of posting a rebuttal from OptumRx, according to the lawsuit.
OptumRx declined to comment on the lawsuit, but a spokesperson for the company previously told Mississippi Today that it has identified errors in the audit’s findings and methodology and submitted them to the Board of Pharmacy.
The Board of Pharmacy declined to comment on ongoing litigation or administrative hearing matters, and HORNE did not respond to Mississippi Today by the time this story published.
OptumRx argued that the audit’s methodology was unfair because it did not investigate the services provided by affiliated, chain and independent pharmacies and instead assumed that all pharmacies dispensing the same prescription drugs offer identical services.
“It is wholly inappropriate to assume parity of service offerings between different types of pharmacies, such as OptumRx’s affiliated (long-term care) pharmacy and retail pharmacy,” wrote the lawsuit.
The audit’s analysis of a generic drug used to treat bacterial infections alleged that an Optum-affiliated pharmacy was paid eight times more than the lowest-paid independent pharmacy on the same day. Chain and affiliate pharmacies were allegedly paid over 20 times as much as independent pharmacies for a generic drug used to treat stomach and esophagus problems.
The audit’s findings have already led to litigation against the company.
In November, Valley Drugs, Inc., a Water Valley pharmacy, filed a class action federal lawsuit against OptumRx and its parent company, UnitedHealth Group, seeking damages for alleged violations of Mississippi’s prescription drug reimbursement regulation and citing the audit’s findings.
OptumRx is owned by health care behemoth UnitedHealth Group Inc., the U.S.’ most profitable health care company and the owner of the nation’s largest health insurance company, UnitedHealthcare. In 2023, the company brought in $32.4 billion in earnings.
OptumRx is the third-largest pharmacy benefit manager in the nation, representing 22% of the industry’s market share in 2023.
A Federal Trade Commission report in July found that in general, large pharmacy benefit managers pay their own, affiliated pharmacies significantly more than other pharmacies and set reimbursement rates at untenably low levels for independent drug stores.
Republish our articles for free, online or in print, under a Creative Commons license.
