Attorney General Gentner Drummond has directed OptumRx, a pharmacy benefit manager (PBM), to stop what he described as illegal efforts to reclaim funds from Oklahoma pharmacies. The action follows reports that OptumRx tried to retroactively adjust payments made to pharmacies after discovering it had used an incorrect Maximum Allowable Cost (MAC) list between January 1 and July 25 of this year.
According to the Attorney General’s Pharmacy Benefit Manager Compliance and Enforcement Unit, OptumRx paid out claims at higher amounts due to the error. The company then reportedly attempted to reverse or rerun these payments without informing affected pharmacies or their representatives, which is not permitted under Oklahoma law.
Drummond sent a cease and desist letter on November 20 demanding that OptumRx immediately stop any effort to recoup payments or adjust reimbursements for the period in question.
“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.”
The Attorney General warned that continued violations of state PBM laws could result in penalties up to $10,000 per violation, restitution, and possible suspension or revocation of OptumRx’s authority to operate within Oklahoma.
