• IPMD United

Independent Pharmacies Sue Major PBM Over Illegal Price Discrimination And Reimbursement Violations

May 15, 2020 Newswire

The newest litigation against a major pharmacy benefit manager (PBM) comes from a likely source: its small business victims. More than 50 independent pharmacies have filed a class action lawsuit against OptumRx, a division of UnitedHealth Group, after the company's failure to comply with state pharmacy claims reimbursement law.

The lawsuit alleges OptumRx acted unlawfully by ignoring state legal requirements, paying local pharmacies substantially less than it paid large chain retail pharmacies like CVS or Walgreens and far below what it paid its own mail order pharmacy for the same prescriptions. The lawsuit further alleges OptumRx often knowingly reimbursed local pharmacies below wholesale cost to stock necessary generic prescription drugs.

PBMs administer the prescription drug portion of health insurance and self-insured plans, acting as a middleman between the insurance plan and the pharmacist. Over the last 20 years these companies have accumulated immense, unregulated power - the three largest PBMs controlling up to 80% of the healthcare market - and have utilized that power to increase prescription drug costs, decrease competition and restrict patient choice.

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