Oklahoma's Attorney General Gentner Drummond is cracking down on the pharmacy benefit manager OptumRx for what he calls "unacceptable, deceptive, and illegal" business practices. A recent cease and desist letter was sent by Drummond after his office stumbled upon reports that OptumRx attempted to unlawfully perform retroactive reimbursement clawbacks from pharmacies in Oklahoma and potentially other states, according to the Oklahoma Attorney General's Office website.
The discrepancy arose due to OptumRx's internal error with its Maximum Allowable Cost (MAC) list that was used since the start of the year, over-inflating pharmacy claims payments between January 1 and July 25 – without the courtesy of a heads-up they made moves to rerun and reverse these transactions behind the pharmacy's backs, and without any proper notification to the involved parties, actions that fly opposite to Oklahoma's set regulations in this industry sector.
"This error and the extended delay in identifying it is solely attributable to OptumRx," Drummond pointed out in a statement, adding, "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." His office is clear in its stance: these maneuvers by OptumRx don't just dance tippety-toe along the line of legality - they outright waltz across it, dismissing the codes that bind fair practice, as stated on the same news.
OptumRx is facing scrutiny as Oklahoma officials warn the company over violations of state PBM laws. The penalties could include fines of up to $10,000 per violation, restitution, and the possible suspension or revocation of its state operating license, underscoring the serious consequences for companies that fail to comply with regulations
