OKLAHOMA CITY – Attorney General Gentner Drummond has issued a cease and desist letter to OptumRx following reports that the pharmacy benefit manager (PBM) attempted to engage in illegal, retroactive reimbursement clawbacks from Oklahoma pharmacies.
The Attorney General’s Pharmacy Benefit Manager Compliance and Enforcement Unit received credible information that OptumRx discovered an internal error concerning the Maximum Allowable Cost (MAC) list used from January 1 to July 25 of this year. The wrong list resulted in claims being paid at increased amounts to pharmacies across multiple states, including Oklahoma. OptumRx reportedly attempted to reverse and rerun previously paid claims without notification to pharmacies or their contract agents, which is against Oklahoma law.
Drummond sent OptumRx the warning letter yesterday demanding OptumRx immediately halt any attempt to recoup payments or retroactively adjust reimbursements for the affected period.
“This error and the extended delay in identifying it is solely attributable to OptumRx. Moreover, this is not the first instance in recent years in which OptumRx has utilized incorrect MAC lists or attempted retroactive recoupments due to its own administrative mistakes,” Drummond wrote in the letter. “This conduct is unacceptable, deceptive, and illegal under Oklahoma law.”
Drummond warned OptumRx that violations of Oklahoma’s PBM laws may result in penalties up to $10,000 per violation, restitution and potential suspension or revocation of the company’s authority to operate in Oklahoma.
