JACKSON • The Mississippi Division of Medicaid isn’t the one state company the place authorities suspect that drug intermediaries could have overcharged taxpayers to extend their earnings lately.
Officers with the Mississippi State and College Staff Well being and Life Insurance coverage Plan additionally suspect that these intermediaries, often known as pharmacy profit directors, cowl almost 200,000 state workers, retirees and their households.
The plan is overseen by the Division of Finance and Administration, however advantages are administered by Blue Cross & Blue Protect of Mississippi, which works with one other firm to ship medication to members.
The 2019 paperwork present that each State Auditor Shad White and former Lawyer Normal Jim Hood initiated an investigation into Blue Cross & Blue Protect of Mississippi and its then pharmaceutical advantages supervisor, Prime Therapeutics, relating to the “improper withholding of refunds. and recoveries “.
After taking workplace final yr, Lawyer Normal Lynn Fitch terminated a contract with the surface legislation agency engaged on the investigation, though a Fitch spokeswoman mentioned this week the case stays open.
The Each day Journal beforehand reported on a separate investigation involving pharmacy profit managers within the state’s Medicaid Division. That investigation is focusing on the state’s largest Medicaid managed care contractor, Centene, a Fortune 50 firm, and presumably others. Mississippi joins a rising checklist of states trying on the opaque world of PBMs, together with Ohio, Oklahoma, Georgia, New Mexico, Kansas, and Arkansas, in addition to Washington, DC, based on The Wall Avenue Journal.
Pharmacy profit managers are subcontractors usually employed by well being plans or employers to handle drug advantages, negotiate drug costs with producers, and reimburse pharmacists. A part of the PBM’s job entails negotiating rebates and different reductions from drug producers, and in return, they supply a most popular location for a drug producer’s product.
Former Mississippi Governor Ronnie Musgrove confirmed that his legislation agency was employed by AG’s workplace to look at these drug reimbursements within the state worker well being plan, even when Blue Cross & Blue Protect of Mississippi and Prime Therapeutics had been transferring the financial savings they obtained to the state.
The previous Democratic governor’s agency was tasked with investigating and presumably taking authorized motion in opposition to BCBS and Prime, underneath a contract with Hood’s workplace. However earlier than Musgrove’s signing might get very far, he mentioned Fitch terminated the contract. A February 2020 termination letter obtained by the Each day Journal doesn’t give a cause.
Fitch spokeswoman Colby Jordan mentioned a number of investigations began underneath Hood “helped inform the litigation we’re presently conducting” and that she was unable to touch upon the state well being plan investigation as a result of it stays an open case and the workplace The lawyer basic desires to “protect our litigation.” technique.”
Fitch is a Republican and Hood is a Democrat.
In a press release to the Each day Journal, Blue Cross & Blue Protect of Mississippi harassed that it doesn’t function a PBM for the state worker well being plan.
The corporate mentioned it does deal with some prescription drug claims, and “to the extent that these prescribed drugs are topic to medical drug reimbursements, 100% of the out there reimbursements are supplied to the (state).” The corporate mentioned it was knowledgeable in late 2019 that the state auditor needed to conduct an audit on each BCBS and Prime Therapeutics, however the audit by no means passed off.
Prime Therapeutics downplayed the significance of the investigation and didn’t straight reply a number of questions from the Each day Journal, together with whether or not it had transferred all reimbursements and different financial savings to the state.
“As a pharmaceutical advantages supervisor, Prime Therapeutics has many contracts with tons of of purchasers,” the corporate mentioned in a press release. “Audits of this nature are routine actions and, as a coverage, we don’t touch upon buyer audit issues.”
Prime Therapeutics is owned by 19 Blue Cross & Blue Protect plans throughout the nation, based on its web site. It had a $ 34 million contract with the state that started in 2016. However Mississippi’s worker well being plan switched to a brand new PBM, CVS Caremark, beginning this yr. A spokeswoman for the Division of Finance and Administration, which oversees the well being plan, mentioned the change to CVS was the results of a routine bidding course of, with CVS offering the successful proposal after Prime’s contract ended.
CVS Caremark can also be dealing with investigations for its PBM practices by attorneys basic in a number of different states. CVS disclosed the investigations in a latest US Securities and Change Fee submitting, noting that state AGs had been inspecting the company’s PBM “pricing and rebates.”
Ohio Lawyer Normal Dave Yost lately sued Centene for allegedly defrauding Ohio taxpayers of hundreds of thousands of dollars by the state’s Medicaid managed care contract with the corporate.
Authorities in Mississippi have mentioned their investigation into Centene is much like that in Ohio. The St. Louis-based firm has strongly denied the allegations.
The Mississippi Medicaid contract with Centene is scheduled to finish on the finish of this month, which might have supplied an outlet for the state’s relationship with the mega-corporation because the investigation into its PBM practices continues.
However Medicaid Division spokesman Matt Westerfield mentioned this week his company will train an non-obligatory extension, permitting Centene’s subsidiary Magnolia Well being to remain on the job for an additional yr. The state’s different two Medicaid managed care firms, UnitedHealthcare and Molina Healthcare, additionally obtained the one-year extension.