June 12, 2019

The Ohio Bureau of Workers’ Compensation and its former pharmacy benefits manager, OptumRx, will try to resolve a $16 million legal dispute through confidential, non-binding mediation.

Franklin County Common Pleas Court Judge Michael Holbrook has postponed trial proceedings in the bureau’s lawsuit against OptumRx after the parties agreed to begin talks in coming weeks. If successful, the case would be dismissed and a public trial avoided.

In March, Ohio Attorney General Dave Yost filed suit on behalf of the bureau demanding repayment from OptumRx, claiming the PBM overcharged the state for prescription drugs for injured workers in violation of its state contract. The bureau has since replaced OptumRx.

According to Yost, the overcharges stem from OptumRX’s failure to adhere to agreed-upon discounts on generic drugs for about three years, as required under its contract with the bureau.

Yost asked for a total of $30 million in compensatory and punitive damages, claiming OptumRX breached its contract with the bureau and committed fraud. OptumRX allegedly increased prices for the bureau’s “commonly utilized” drugs “without explanation.”

The bureau “learned the sudden price increases were actually part of (OptumRX's) strategy to subsidize lower prices charged to its other clients,” Yost said. “By charging higher prices to (the bureau, OptumRX) could provide larger discounts to other clients.”

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OptumRx officials have disputed Yost’s claims, arguing that they saved the bureau money on prescription drugs.