$15 Million OptumRx Settlement Pushes AG Yost’s Total Recoveries From PBMs Past $100 Million


Columbus,OH(WorkersCompensation.com) - Under an agreement announced today by Ohio Attorney General Dave Yost, OptumRx will repay the state $15 million in prescription-drug overcharges assessed to the Ohio Bureau of Workers’ Compensation (BWC), raising the Yost administration’s total recoveries from pharmacy benefit managers to more than $100 million.

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

Pharmacy benefit managers (PBMs) are private companies that contract with state agencies to manage prescription-drug costs for clients of the agencies. PBMs have been the target of lawsuits in Ohio and other states after some PBMs were found to have charged states far more for drugs than they paid pharmacists to fill the prescriptions.

Yost’s lawsuit against OptumRx alleged that the Irvine, California-based company overcharged BWC $15.8 million from Jan. 1, 2015, to Oct. 27, 2018. The complaint asserted that the company failed to manage the costs of generic medications in accordance with contractually agreed-upon discounts.

In November 2019, the state filed an amended complaint alleging that OptumRx breached its contract by applying an incorrect reimbursement rate to certain claims for generic drugs and by failing to achieve a target reimbursement rate for certain pharmacy claims during the final two-year contract extension. OptumRx denied the allegations.

Under the settlement agreement, OptumRx admits no wrongdoing or liability.

Along with the OptumRx case, Yost has pursued two other similar cases:

  • In June 2021, just three months after Yost sued Centene Corp, the company agreed to pay Ohio $88.3 million for overcharges to the Ohio Department of Medicaid.
  • In July 2020, Yost filed a lawsuit on behalf of the Ohio Highway Patrol Retirement System accusing Express Scripts of multiple contract breaches that enabled the company to pocket millions in overcharges. This case is pending.  

“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,” the attorney general said. “Stay tuned.”

Hannah Hundley: 614-906-9113


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