PBM Regulatory Roundup (Fall 2022): State Medicaid Enforcement Efforts Continue As Legislative Activity Slows Down

Though the flurry of state PBM-focused legislation slowed down with the summer recess, there has still been plenty of noteworthy PBM news. This roundup focuses on state Medicaid enforcement activities involving Centene and provides a brief overview of recent legislative activity.

State Medicaid Enforcement

Centene Corporation, on behalf of itself and its subsidiaries (collectively, Centene), has been subject to a number of state investigations alleging that certain of Centene’s managed care organizations and Centene’s PBM, Envolve Pharmacy Solutions, together participated in state-specific schemes to misrepresent pharmacy costs, artificially inflate fees, and ultimately overcharge applicable state Medicaid programs. These investigations focused primarily on transparency.

In June 2021, Centene settled the matter of Ohio Department of Medicaid and State of Ohio v. Centene Corporation et al. for $88.3 million. Immediately following the Ohio settlement, Centene and the State of Mississippi agreed to a $55.5 million settlement to resolve materially similar issues. Since then, Centene has settled with several other states over similar accusations, including, Arkansas ($15.2 million), Kansas ($27.6 million), Illinois ($56.7 million), New Hampshire ($21.1 million), and New Mexico ($13.7 million); and is rumored by some news outlets to have settled with Georgia and Oklahoma.

Source: PBM Regulatory Roundup (Fall 2022): State Medicaid Enforcement Efforts Continue As Legislative Activity Slows Down / Mintz

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