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Optum audit shows possible law violation, lower payments to independent pharmacies

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Optum audit shows possible law violation, lower payments to independent pharmacies


The findings of a recent audit of a major company that manages prescription benefits revealed it may have violated Mississippi law.

The review of Minnesota-based Optum’s business practices by the Mississippi Board of Pharmacy indicated that the company paid independent pharmacies in Mississippi rates lower than chains and Optum-affiliated pharmacies for the same prescription drugs. 

The audit uncovered over 75,000 instances in which Optum-affiliated pharmacies’ lowest payments for a prescription drug were higher than at unaffiliated pharmacies in one year, including chain and independent drug stores. 

Mississippi state law prohibits pharmacy benefit managers from reimbursing their affiliate pharmacies, or ones they own, at higher rates than non-affiliate pharmacies for the same services. 

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In some cases, patients footed the bill: consumers were almost twice as likely to pay the full cost of a prescription drug claim without contributions from their insurance plan at independent pharmacies than at affiliated pharmacies. 

The Board of Pharmacy will hold an administrative hearing based on the alleged violations of Mississippi law on Dec. 19. Board staff declined to answer questions about the audit or its findings. 

“I think this proves that we need to have more transparency, we need to have more PBM reform in Mississippi and across the country and even on a federal level,” said Robert Dozier, the executive director of the Mississippi Independent Pharmacy Association, an organization that advocates for 180 pharmacy members.

Optum declined to answer specific questions about the audit. The company has identified errors in the audit’s findings and methodology and submitted them to the Board of Pharmacy, said Isaac Sorenson, a spokesperson for Optum. 

“The pharmacy – and local pharmacists – play a vital role in supporting people’s health and we are committed to paying them fairly,” he said. “…For pharmacies in rural and underserved communities, Optum Rx is deepening its commitment to support their role by launching new programs, expanding existing initiatives and launching a new pharmacy network option for customers.” 

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He said the new pharmacy network option will provide pharmacies with increased reimbursements. Generic drugs will be reimbursed at 5% higher rates and brand name drugs at .2% higher rates. 

Optum is owned by health care behemoth UnitedHealth Group Inc., the U.S.’ most profitable health care company and the owner of the nation’s largest health insurance company, UnitedHealthcare. In 2023, the company reaped $32.4 billion in earnings. 

Pharmacy benefit managers are private companies that act as middlemen between pharmacies, drug manufacturers and insurers. They process prescription drug claims, negotiate pricing and conditions for access to drugs and manage retail pharmacy networks. 

Optum is one of the largest three pharmacy benefit managers in the U.S., which together account for 79% of prescription drug claims nationwide. 

The results of the audit echoed some of the conclusions of a Federal Trade Commission report published in July: large pharmacy benefit managers pay their own, affiliated pharmacies significantly more than other pharmacies and set reimbursement rates at untenably low levels for independent drug stores, or retail pharmacies not owned by a publicly traded company or owned by a large chain, said the report. 

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Mississippi Today reported last month that many Mississippi independent pharmacists fear they may be forced to close their businesses due to low reimbursement rates from pharmacy benefit managers. 

Pharmacy benefit managers have an incentive to steer customers towards their affiliate pharmacies and compensate them at higher rates, which can disadvantage unaffiliated pharmacies and lead to higher drug costs, said the Federal Trade Commission. 

Optum’s affiliate pharmacies include Optum Home Delivery Pharmacy and Optum Specialty Pharmacy. 

The audit revealed that Optum uses 49 different maximum cost lists, or schedules created by pharmacy benefit managers that determine the highest price they will pay pharmacies for generic drugs. Maximum cost lists are proprietary and confidential, even to the pharmacies that are reimbursed based on the lists, and change continuously.

“I think that’s 48 too many,” said Dozier. “There should only be one MAC list.”

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Fifteen are used exclusively at independent pharmacies and 22 are used solely at chain pharmacies. 

An analysis of the maximum allowable cost lists showed that independent pharmacies were reimbursed at rates 74% lower than chain pharmacies on average.

An analysis of a generic drug used to treat bacterial infections yielded a payment to an Optum-affiliated pharmacy that was eight times higher than the lowest-paid independent pharmacy on the same day. Chain and affiliate pharmacies were paid over 20 times as much as independent pharmacies for a generic drug used to treat stomach and esophagus problems.

Pharmacies’ attempts to contest low reimbursement rates were often unsuccessful, showed the audit. 

Ninety-eight percent of pharmacy appeals were denied, most commonly because they did not include information about how much the pharmacy paid to acquire the medication from a wholesaler. 

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Mississippi law prohibits pharmacy benefit managers from reimbursing pharmacies at rates below their cost to acquire the drug, even when using a maximum allowable cost list. But the audit revealed over 400 times that Optum denied pharmacies’ appeals on those grounds, saying that the maximum cost list was accurate. 

The audit, which studied Optum in 2022, was the first commissioned by the Mississippi Board of Pharmacy after revisions to state law in 2020 gave it more regulatory authority over pharmacy benefit managers. 

It took the board several years to hire staff to enact the law and receive approval to increase its budget due to the high costs of audits, the board’s executive director Susan McCoy told lawmakers at the House Select Committee on Prescription Drugs Aug. 21 at the Capitol.

The board also has pending administrative proceedings with the other largest pharmacy benefit managers in the country, Express Scripts and CVS Caremark. Neither is the result of an audit. Both hearings are scheduled for Nov. 21. 

Optum has already faced scrutiny for its business practices in Mississippi. In August, Attorney General Lynn Fitch filed a lawsuit alleging that Optum and several other pharmacy benefit managers stoked the opioid epidemic by plotting with manufacturers to increase sales of the addictive drugs and boost their profits. The suit also named Evernorth Health and Express Scripts, along with the companies’ subsidiaries. 

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CBSB: Southern Miss sweeps again, Mississippi State shines in Texas, Ole Miss struggles – SuperTalk Mississippi

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CBSB: Southern Miss sweeps again, Mississippi State shines in Texas, Ole Miss struggles – SuperTalk Mississippi


Southern Miss earned its second consecutive sweep, rounding out a mostly successful weekend of college baseball for Mississippi’s major programs.

The No. 12 Golden Eagles (10-1), fresh off a mercy-rule victory over Alabama, exited a hostile Louisiana Tech environment with three straight wins versus a former conference counterpart. Christian Ostrander’s crew won 8-3 on Friday, cruised to an 11-0 run-rule victory through seven innings on Saturday, and was on the good side of a 6-2 scoreboard in Sunday’s finale.

A three-run bomb by Kyle Morrison in the top of the fourth of Friday’s game put the black and gold up 5-3, and solid pitching carried the team the rest of the way. A six-run top of the fourth of Saturday’s game, in part due to a Matthew Russo 2 RBI single, broke a scoring stalemate and fueled Southern Miss to a win in a shortened matchup. A two-run long ball by Joey Urban in the top of the ninth of Sunday’s battle gave the Golden Eagles a buffer that would not be eclipsed.

Kros Sivley (2-0) was Friday’s winning pitcher after logging a pair of strikeouts in 1.2 innings. Grayden Harris (2-0) got the win on Saturday after fanning five batters and surrendering no runs through six complete innings. Camden Sunstrom (1-0) closed out the finale with the win after striking out two batters and not giving up a hit or a run in the final two frames.

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Mississippi State wins two in Texas

The No. 4 Bulldogs (11-1) had a solid weekend in the Amegy Bank College Baseball Series. Brian O’Connor’s club handled the weekend test with an 8-4 win over Arizona State, a 15-8 victory over Virginia Tech, and a heartbreaking 8-7 extra-innings loss to No. 1 UCLA.

Mississippi State broke a scoring hiatus on Friday with a strong bottom of the fifth. A Bryce Chance RBI single scored the game’s first run, then a Gehrig Frei homer put the Bulldogs up 4-0. Three insurance runs were added in the next offensive frame, and Mississippi State did not look back. On Saturday, an Ace Reece longball gave the maroon and white a 4-0 lead in the top of the second. Virginia Tech chipped away, cutting the deficit to two runs, until a five-run top of the seventh put things out of reach.

Sunday’s finale was a battle between two teams vying for bragging rights as the nation’s best. The Bruins took an early 3-0 lead, but Mississippi State quickly countered. A two-run bomb by Reed Stallman and an RBI double by Ryder Woodson knotted things up 3-3 in the bottom of the fourth. The Bulldogs added a run in the bottom of the seventh and eighth innings to lead 5-3.

A two-out home run by UCLA’s Roch Cholowsky tied the ballgame in the top of the ninth. Mississippi State, with runners on second and third and no outs in the bottom of the ninth, could not send a runner home. A wild pitch and a 2 RBI triple scored three Bruins in the top of the 10th. Stallman hit his second home run of the day to inch the Bulldogs within one run of their foe, but it was not followed up with more scoring.

Winning pitchers for Mississippi State this weekend were Ryan McPherson (2-0) and Tomas Valincius (3-0), while Ben Davis (0-1) was tabbed with the lone loss.

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Ole Miss struggles in neutral-site tournament

In its first set of tests versus power conference opponents, the Rebels (10-2) struggled mightily, dropping two of three outings in the BRUCE BOLT College Classic. Mike Bianco’s club fell to Baylor 6-5 in extra innings on Friday before bouncing back on Saturday in an 8-0 win over Ohio State and suffering a 9-2 loss to Coastal Carolina in Sunday’s finale. Ole Miss was a combined 0-18 at the plate with runners in scoring position in the two losses.

Though the weekend didn’t play to the Rebels’ advantage, a few individual performers stood out. Murray State transfer Dom Decker, who entered his junior campaign without hitting a home run, hit three balls over the outfield wall at the Houston Astros’ Daikin Park. Hunter Elliott had a career-high 11 strikeouts on Friday, while Cade Townsend and Taylor Rabe collectively fanned 16 batters in Saturday’s shutout.

Next up

Southern Miss will play a pair of home midweek games, the first being against Mississippi State on Tuesday at 6 p.m. and the second versus Nicholls on Wednesday at 6 p.m., before hosting North Alabama over the weekend.

Mississippi State will host Lipscomb over the weekend after facing the Golden Eagles.

Ole Miss will host Memphis on Tuesday at 6:30 p.m. and North Alabama on Wednesday at 6:30 p.m., before welcoming Evansville for a weekend series.

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Mississippi State women’s basketball vs LSU, Kim Mulkey score, live updates, start time, TV

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Mississippi State women’s basketball vs LSU, Kim Mulkey score, live updates, start time, TV


STARKVILLE — Mississippi State women’s basketball is playing its final regular season game against No. 6 LSU at Humphrey Coliseum on March 1 (3 p.m., SEC Network).

The Bulldogs (18-11, 5-10 SEC) enter the game on the NCAA Tournament bubble after losing three consecutive games, so an upset win could secure an at-large bid.

The Tigers (25-4, 11-4) and coach Kim Mulkey have won three straight games. Their only losses of the season are to Kentucky, Vanderbilt, Texas and South Carolina.

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The Clarion Ledger is bringing you live updates from the game. Follow along.

Watch Mississippi State vs LSU

Mississippi State vs LSU score updates

What time does Mississippi State vs LSU start?

  • Date: Sunday, March 1
  • Time: 3 p.m.
  • Where: Humphrey Coliseum

What TV channel is Mississippi State vs LSU on today?

Mississippi State vs LSU prediction

  • Sam Sklar, The Clarion Ledger: LSU 77, Mississippi State 74

Mississippi State vs LSU injury report

Mississippi State

None

LSU

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  • Meghan Yarnevich: Out
  • Kailyn Gilbert: Out

Mississippi State women’s basketball schedule 2025-26

Remaining games on the Mississippi State schedule:

  • March 4-8: SEC Tournament in Greenville, South Carolina

Sam Sklar is the Mississippi State beat reporter for The Clarion Ledger. Email him at ssklar@usatodayco.com and follow him on X @sklarsam_.



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Virginia Tech Drops 15-8 To Mississippi State

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Virginia Tech Drops 15-8 To Mississippi State


ARLINGTON, Texas — Mississippi State capitalized on free passes and timely hitting to pull away from Virginia Tech late, defeating the Hokies 15-8 Saturday at Globe Life Field.

The Bulldogs (11-0) collected 15 hits and went 8-for-16 with runners in scoring position, taking control with a five-run seventh inning before tacking on three more scores in the eighth and two in the ninth.

Mississippi State struck first in the opening inning. Aidan Teel singled and later scored on Reed Stallman’s RBI double to right, giving the Bulldogs a 1-0 lead against Virginia Tech starter Griffin Stieg.

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The Hokies fell behind further in the second when Teel delivered an RBI single and Ace Reese followed with a 399-foot two-run home run to right-center, pushing the margin to 4-0.

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Virginia Tech answered in the third. Hudson Lutterman tripled to right field and Ethan Gibson lifted a sacrifice fly to cut the deficit to 4-1. But the Bulldogs continued to manufacture offense, adding a run in the fifth after a hit-by-pitch with the bases loaded made it 5-1.

The Hokies began to chip away in the sixth when Ethan Ball launched a 448-foot solo home run to center field, trimming the lead to 5-2. Virginia Tech threatened further in the inning after Owen Petrich reached and Treyson Hughes moved into scoring position following an error, but a strikeout and a caught stealing ended the rally.

The game swung decisively in the seventh.

Mississippi State loaded the bases against Aiden Robertson and Peyton Smith before James Nunnallee was hit by a pitch to force in a run. Bryce Chance followed with an RBI single, and Teel delivered a two-run single through the right side. An Ace Reese sacrifice fly capped the five-run inning, extending the Bulldogs’ lead to 10-2.

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Mississippi State added three more in the eighth on Jacob Parker’s 415-foot, three-run home run to right-center, stretching the advantage to 13-2.

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Virginia Tech was able to answer to aviod the run-rule decision. In the bottom half of the eighth, Nick Locurto advanced on a wild pitch before Aimon Chandler crushed a two-run homer to left-center to make it 13-5.

The Bulldogs answered again in the ninth, taking advantage of walks and another hit-by-pitch to plate two more runs and push the lead to 15-5.

The Hokies mounted one final rally in the bottom of the ninth, launching three consecutive solo home runs. Anderson French homered to open the inning, Hudson Lutterman followed with a blast of his own and Sam Gates added another to trim the deficit to 15-8. The comeback attempt stalled there, however, as Mississippi State recorded the final three outs to secure the win.

Virginia Tech finished with 11 hits and hit seven home runs in the contest, but the difference proved to be traffic. The Hokies issued 10 walks and hit four batters, allowing Mississippi State to consistently put runners on base. The Bulldogs stranded 12 but capitalized often enough to keep control.

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Ball, Chandler, French, Lutterman and Gates each homered for the Hokies, while Mississippi State countered with long balls from Reese and Parker.

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Despite the late power surge, Virginia Tech could not overcome Mississippi State’s sustained offensive pressure and struggled to contain innings once they began to unravel.

The Hokies will look to regroup as they finish tournament play tomorrow against Tennessee.



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