Mississippi

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

Published

2 months ago

November 7, 2024

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.

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.”

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.

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.”

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.

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.

Source link

Mississippi

MDOC searches for escaped prisoner from South Mississippi Correctional Institution

Published

7 hours ago

December 25, 2024

Press Room

MDOC searches for escaped prisoner from South Mississippi Correctional Institution

The Mississippi Department of Corrections, with the help of other authorities, is searching for a prisoner who escaped Tuesday afternoon from the South Mississippi Correctional Institution in Leakesville.

Drew Johnson, 33, has blond hair and blue eyes. He weighs 200 pounds and is 6 feet tall.

Johnson was sentenced in 2022 to life in prison for a homicide/murder in Rankin County.

Anyone who believes they may have seen Johnson should contact the nearest law enforcement agency.

Source link

Mississippi

MDOC searching for escaped inmate out of South Mississippi Correctional Institution in Leakesville

Published

15 hours ago

December 24, 2024

Press Room

MDOC searching for escaped inmate out of South Mississippi Correctional Institution in Leakesville

LEAKESVILLE, Miss. (WLOX) – The Mississippi Department of Corrections, with the help of other authorities, is searching for an inmate who escaped the South Mississippi Correctional Institution in Leakesville Tuesday afternoon.

According to an alert sent out by the Greene County Emergency Management office, 33-year-old Drew Johnson escaped from the facility around 3:30 p.m. He’s currently serving a life sentence for murder.

He was sentenced on February 14, 2022.

Drew Johnson is described as a 6′0″ male with blue eyes, blonde hair, and 200 pounds.(Mississippi Department of Corrections)

Johnson is described as a 6′0″ male with blue eyes, blond hair, and 200 pounds. He was last seen near Old Highway 24 in Leakesville.

Crews are still out searching for him as of 8:03 p.m. If you have any details regarding the incident or see Johnson, officials say to call 911.

We will update this story as new details become available.

See a spelling or grammar error in this story? Report it to our team HERE.

Source link

Mississippi

What MS Coast casino restaurants are open Christmas Day? Here’s our list

Published

1 day ago

December 24, 2024

Press Room

What MS Coast casino restaurants are open Christmas Day? Here’s our list

Christmas on the Coast is a tradition for many families throughout the Southeast. Mississippi Coast casinos are ready to welcome them with open arms and open restaurants.

Below are the casinos open for dining on Christmas Day, some with limited holiday fare. Reservations may be required for some restaurants.

875 Beach Blvd., Biloxi, 228-386-7111.

BR Prime

Reservations required.

Holiday Bouillabaisse, Icy Blue Mussels, Little Neck Clams, Gulf Shrimp, Seabass $15
Prime Rib with Demi Glace, Thyme Horseradish Cream, Hasselback Potatoes, Heirloom Carrots, Roasted Brussels Sprouts $72
Peppermint Hot Chocolate Cheesecake $15

Salt and Ivy

Reservations encouraged.

Christmas Feature $38: Crab, Shrimp and Spinach-stuffed Flounder with Dill Bearnaise, Wild Mushroom Farro and White Wine-Garlic Broccolini

The Buffet

Holiday Brunch: 8 a.m. to 10 a.m., Adults, $32.99; Children, $19.99; Under 4, free.

Holiday Lunch/Dinner: 10 a.m. to 10 p.m., Adults, $49.99; Children $25.99; Under 4, free.Free Under 4

Features include herb-crusted prime rib, spicy shrimp boil, NOLA BBQ shrimp and grilled sirloin

151 Beach Blvd., Biloxi, 228-435-5400.

Morton’s The Steakhouse

Reservations recommended. Restaurant hours: noon to 9 p.m.

The Chateaubriand three-course menu for two includes Chateaubriand with Roasted Shallots, Red Wine Demi Reduction, Sauce Bearnaise and Au Jus; Winter Salad to share; choice of two sides; and choice of desserts for $179. Lobster tails or mini crab cakes are available at an extra cost.

Lillie’s Asian Cuisine

Restaurant hours: 4 p.m. to 10 p.m.

Saltgrass Steak House

Restaurant hours: 10:30 a.m. to 6 p.m.

Bubba Gump Shrimp Co.

Restaurant hours: noon to 8 p.m.

Michael Patrick’s

Restaurant hours: 8 a.m. to 9 p.m.

777 Beach Blvd., Biloxi, 228-374-7625.

Christmas Day Buffet, $39.99 from 4 p.m. to 8 p.m.

Menu includes starters, a carving station, Satisfaction favorites such as Southern Fried Chicken and Stuffed Crabs, Asian Cuisine, sides and desserts.

711 Hollywood Blvd., Bay St. Louis, 228-469-2100.

Epic Buffet

Restaurant hours: 11 a.m. to 7 p.m.

The Epic Buffet features more than 80 dishes including Crab Legs, Peel and Eat Shrimp, Southern barbecue, Asian cuisine, Creole, Italian and fresh seafood.

3300 West Beach Blvd., Gulfport, 228-314-2100.

The Buffet

Christmas Day hours: 11 a.m. to 10 p.m.

Low Country Crawfish Bisque; Creole Seafood Gumbo; Carrot Soufflé Casserole; Praline-Crusted Sweet Potatoes; Orange Chicken with Vegetables; Crispy Fried Shrimp; Carved Roast Turkey; Carved Strip Loin of Beef; Cornbread Dressing; Sliced Roast Turkey in Giblet Gravy; Carved Round of Beef, Smoked Ham and Cajun Fried Turkey; Cranberry Compote; Roasted Salmon Loin; Boiled Gulf Shrimp with Remoulade Sauce; Happy Family Shrimp and Vegetables; Smoked Pork with all the Trimmings; and more, $29.99.

C and G Grille

Christmas Day hours: 10:30 a.m. to 11 p.m., $26.

Choice of Starter: Seafood Gumbo or House Salad
Choice of Entrée: Roast Turkey and Dressing or Glazed Bone-In Ham Steak. Each served with Green Bean Casserole, Candied Sweet Potatoes and Cranberry Compote
Dessert: Cookie Butter Banana Pie

The Diner

Christmas Day hours: 10 a.m. to 10 p.m., $20.

Choice of Starter: House Salad or Seafood Gumbo
Entrée: Roast Turkey with Dressing, Gravy, Cranberry Sauce and Green Beans
Dessert: Sweet Potato Pie with Whipped Cream

Dockside Deli

Christmas Day hours: 11 a.m. to 9 p.m., $21.

Starter: Crab and Corn Bisque or Seafood Gumbo
Choice of Entrée: Debris-Style Turkey Dressing, Green Beans, Cranberry Compote and Carrot Soufflé Casserole or Sausage Sampler with pineapple jalapeno, knockwurst and green onion sausages. Served with red kraut and warm potato salad.
Dessert: Spiced Applesauce Cake

Prime Cut Restaurant

Christmas Day hours: 5 p.m. to 10 p.m., $45.

Starter: Crab and Artichoke-Stuffed Mushrooms Drizzled with Hollandaise
Choice of Entrée: Beef Tenderloin au Poivre or Pan-Seared Sea Bass with lemon beurre blanc. Each served with a side of choice
Dessert: Pumpkin Swiss Cake Roll

158 Howard Ave., Biloxi, 228-432-8888

Restaurant hours: 11 a.m. to 9 p.m., $40.

Traditional Christmas menu plus Prime Rib, Smoked Baked Ham, Sliced Turkey Breast, Boiled Shrimp and dishes from the Grill, Comfort, Wok and Coastal stations.

9380 Central Ave., D’Iberville, 888-752-9772.

Under the Oak Cafe

Christmas Day hours: 11 a.m. to 10 p.m.

Herb Dijon Crusted Pork Tenderloin with Sweet Potatoes Puree, Roasted Brussels Sprouts with Bacon and Cranberries and an Herb Dijon Reduction, $25.
Creamy Eggnog Bread Pudding, $14.

Scarlet’s Steaks and Seafood

Reservations recommended. Christmas Day hours: 4 p.m. to 9 p.m.

Lobster Thermidor, Broiled Coldwater Stuffed Lobster topped with Mushroom Cognac Cream Sauce, Parmigiana Reggiano, Garlic Butter Breadcrumbs and Wilted Arugula Salad, $80.
Beef Wellington, 8-ounce filet mignon, with Mushroom Duxelles, Prosciutto and baked in Puff Pastry, served with Bordelaise Sauce, $78.
Creme de Mint Cheesecake, $13

5000 South Beach Blvd., Bay St. Louis, 228-469-2777.

Jubilee Buffet

Christmas Day hours: 11 a.m. to 9 p.m.

Traditional holiday menu plus, all-you-can-eat Dungeness Crab and Jumbo Shrimp, $49.95.

Blue Bayou Bar and Grill

$58 per person.

Salad: Baby Spinach with Candied Pecans, Dried Cranberries, Mandarin Orange, Goat Cheese, Roasted Cacao Nibs and a Citrus Vinaigrette.
Entrée: Choice of Crispy Roasted Half Duck, Braised Red Cabbage, Port Wine Demi Glaze and Whipped Roasted Garlic Mash or Blackened Pork Loin, Pomegranate Glaze, Bacon Braised Crispy Brussels Sprouts and Sweet Potato Gratin

1980 Beach Blvd., Biloxi, 228-385-6000.

Infinity Buffet

Christmas Day hours: 11 a.m. to 10 p.m.

Carved ham, roasted turkey, roast brisket and more, $47.99 with crab, $25.49 without crab.

The Den

Christmas Day hours: 11 a.m. to midnight.

Bacon-wrapped stuffed pork loin, $38; or prime rib, $45.

The following casinos will be open Christmas Day but restaurant options were not available:

280 Beach Blvd., Biloxi, 228-436-2946.

850 Bayview Ave, Biloxi, 228-436-3000.

Lici Beveridge is a reporter for the Hattiesburg American and Clarion Ledger. Contact her at lbeveridge@gannett.com. Follow her on X  @licibev or Facebook at facebook.com/licibeveridge.

Source link