Connect with us

Mississippi

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

Published

on

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. 

Advertisement

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.” 

Advertisement

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. 

Advertisement

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.”

Advertisement

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. 

Advertisement

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. 

Advertisement

Republish our articles for free, online or in print, under a Creative Commons license.





Source link

Advertisement

Mississippi

Mississippi Lottery Mississippi Match 5, Cash 3 results for June 25, 2026

Published

on

Mississippi Lottery Mississippi Match 5, Cash 3 results for June 25, 2026


play

The Mississippi Lottery offers several draw games for those aiming to win big.

Here’s a look at June 25, 2026, results for each game:

Advertisement

Winning Mississippi Match 5 numbers from June 25 drawing

01-06-09-13-23

Check Mississippi Match 5 payouts and previous drawings here.

Winning Cash 3 numbers from June 25 drawing

Midday: 3-3-8, FB: 5

Evening: 4-0-8, FB: 7

Check Cash 3 payouts and previous drawings here.

Advertisement

Winning Cash 4 numbers from June 25 drawing

Midday: 2-8-3-2, FB: 5

Evening: 5-0-3-2, FB: 7

Check Cash 4 payouts and previous drawings here.

Winning Cash Pop numbers from June 25 drawing

Midday: 01

Evening: 07

Advertisement

Check Cash Pop payouts and previous drawings here.

Feeling lucky? Explore the latest lottery news & results

Story continues below gallery.

Are you a winner? Here’s how to claim your lottery prize

Winnings of $599 or less can be claimed at any authorized Mississippi Lottery retailer.

Advertisement

Prizes between $600 and $99,999, may be claimed at the Mississippi Lottery Headquarters or by mail. Mississippi Lottery Winner Claim form, proper identification (ID) and the original ticket must be provided for all claims of $600 or more. If mailing, send required documentation to:

Mississippi Lottery Corporation

P.O. Box 321462

Flowood, MS

39232

Advertisement

If your prize is $100,000 or more, the claim must be made in person at the Mississippi Lottery headquarters. Please bring identification, such as a government-issued photo ID and a Social Security card to verify your identity. Winners of large prizes may also have the option of setting up electronic funds transfer (EFT) for direct deposits into a bank account.

Mississippi Lottery Headquarters

1080 River Oaks Drive, Bldg. B-100

Flowood, MS

39232

Advertisement

Mississippi Lottery prizes must be claimed within 180 days of the drawing date. For detailed instructions and necessary forms, please visit the Mississippi Lottery claim page.

When are the Mississippi Lottery drawings held?

  • Cash 3: Daily at 2:30 p.m. (Midday) and 9:30 p.m. (Evening).
  • Cash 4: Daily at 2:30 p.m. (Midday) and 9:30 p.m. (Evening).
  • Match 5: Daily at 9:30 p.m. CT.
  • Cash Pop: Daily at 2:30 p.m. (Midday) and 9:30 p.m. (Evening).

This results page was generated automatically using information from TinBu and a template written and reviewed by a Mississippi editor. You can send feedback using this form.



Source link

Continue Reading

Mississippi

Mississippi Legislature will talk school choice, redistricting in 2027

Published

on

Mississippi Legislature will talk school choice, redistricting in 2027


play

  • Mississippi state leaders are preparing for the 2027 governor’s race by outlining their legislative priorities.
  • Redistricting legislative and congressional maps is a top priority for the upcoming legislative session.
  • Lawmakers are divided on education reform, with some favoring school choice and others focusing on public school funding.
  • Republican leaders agree on the need to reduce the size of state government, though they propose different methods.

PHILADELPHIA — When asked about his campaign plans for the statewide elections in November 2027, Lt. Gov. Delbert Hosemann has avoided giving a straight answer. Usually, he tells the media that his next focus is a long checklist of priorities to tackle next legislative session.

The governor’s race next year, the first this decade without term-limited incumbent Gov. Tate Reeves, is rumored to feature a crowded field. For current officeholders, even those who don’t work directly with the state Legislature, the bills that they can endorse and urge across the finish line are often the feathers in their cap touted on the campaign trail.

Advertisement

During the two days of political speaking at the Neshoba County Fair, Hosemann and other state leaders gave attendees a clearer view of what their goals are for those 60 days of debate.

Redistricting

One of the priorities common to most speakers was legislative and congressional redistricting in the wake of the U.S. Supreme Court decision that prohibited drawing voting districts on the basis of race. Reeves initially called a special session on redistricting, specifically regarding the state Supreme Court districts, but he later canceled it.

The governor opted to cancel the session, he said, because Mississippi had already had its primary. Instead, he charged Hosemann and House Speaker Jason White, the leaders of each chamber, with navigating the process during the next legislative session.

Through their redistricting committees, both said at the Neshoba County Fair, they are preparing to do exactly that.

Advertisement

“The Democrats used [prior Supreme Court rulings] to make sure they elected Democrats and not the people that you wanted. Now the Supreme Court has changed that, and we’re back to ground one where we should be,” Hosemann said. “We’ve appointed a committee, they’ll be out in Mississippi … looking at who do you want to represent you and how is your district to be set up? It’s coming back to the people where it was before, where it should be today.”

Mississippi Rep. Scott Bounds and Sen. Lane Taylor, both of whom represent the Neshoba County area, are on their respective redistricting committees. Both promised that redistricting is among the first issues that the Legislature plans to take up in January, with Bounds adding that the focus is on redrawing the state legislative districts.

“I believe the best way to enact common sense, conservative policies is by electing Republicans to office,” Jason White said. “The Mississippi House of Representatives stands for that, and we will examine redistricting and elect more Republicans to local, state and federal offices.”

Reeves confirmed that he “would not be surprised” if there is a special session before the next legislative session begins in January, but that even without it, the Legislature “would definitely have redistricting done” before the statewide elections in November 2027. Reeves has the power to call a special session at any point.

Advertisement

K-12 and higher education

Hosemann and White took, if not opposite perspectives, then at least different approaches to improving the state’s public and higher education systems.

White’s primary focus, he said in his speech, lays again with school choice. He told the crowd that, while lawmakers were still drafting legislation, Mississippians could expect to see a similar attempt this upcoming year as representatives put forward in January.

“I think you’ll see most statewide candidates for governor fully endorsing the idea of school choice and pushing it forward. I think the reason they will do that is because they’re smart, they’ve been polling, they’re spending their money to see what issues are important to people,” White said after giving his speech. “They’re finding out that when you get outside of the room and have a real conversation with parents, they want those choices.”

The 500-page, sweeping bill from last year primarily proposed using state money to fund vouchers for students to attend private and charter schools. It passed the House, where it originated, in a narrow vote before getting a resounding “no” vote in the Senate education committee.

Advertisement

“I wish the Senate would come forward and say, ‘Look, we don’t want to go through all that again. Here’s what we would do,’” White said. “I wish there would be a way to find a win-win, but to this point, they’ve been unwilling to have a conversation. That makes it tough politics for me when they’re unwilling to even have a conversation.”

Hosemann has loudly opposed state-funded vouchers, and he took the dais to advocate for more funding in public schools. One of his education priorities for the next year, he told the crowd, was opening more special-purpose schools for children with disabilities and developmental disorders such as autism.

Where Hosemann and White have agreed is that Mississippi’s education systems are bloated. Hosemann spoke specifically about higher education, telling reporters after his speech that some institutions graduate fewer than 25% of their enrollment. He touted the benefits of performance-based funding in ensuring that schools are motivated to educate high-performing students, and Mississippians could likely see changes to the funding formula in 2027.

White has largely focused, for the moment, on K-12 public schools. He formed a committee on school consolidation that has zeroed in on small schools and districts, and top officials with the state education department have asked for the Legislature to draft a framework for closing schools in the coming years.

Advertisement

How big should the government be?

Maybe the only thing that every Republican speaker agreed on was that Mississippi’s government needs to be smaller, but they phrased reform in different ways.

Reeves promoted artificial intelligence that makes workflows more efficient and decreases the number of state employees needed to do a certain job. White urged the government to decrease property taxes, because the burden makes property owners “feel like they rent the property that they own.”

Hosemann pointed to a Senate committee on efficiency and transparency that has moved to eliminate 17 government committees and boards he described as useless. White formed a similar special committee on government efficiency that has met over the summer to weigh cost-cutting measures.

While details on which departments could be downsized and precise estimates of potential savings have not been publicly outlined, nearly every state official, member of the Legislature and candidate who spoke at the Neshoba County Fair promised significant reform next session.

Advertisement

Bea Anhuci is the state government reporter for the Clarion Ledger. She has covered Mississippi politics since the start of 2026. Email her at banhuci@usatodayco.com.



Source link

Continue Reading

Mississippi

Where to see fireworks and celebrate Fourth of July in, near Jackson

Published

on

Where to see fireworks and celebrate Fourth of July in, near Jackson



Celebrate the Fourth of July at these free events with fireworks displays in the Jackson area.

play

Independence Day is always an exciting holiday in Mississippi with burgers and hot dogs sizzling on the grill and the dazzling displays of fireworks.

This year is even more special as America celebrates its 250th birthday. It is a celebration of a milestone not to be missed and the fireworks displays will be spectacular.

If you live in the Jackson area there are plenty of events to choose from and not all of them are on Saturday, July 4, so you can go and enjoy more than one. To make them even better, the events are free.

So, here are some of the area events that include fireworks where you can celebrate America 250.

Advertisement

Jackson Fireworks Extravaganza

  • When: 5 p.m., Wednesday, July 1
  • Where: Smith Wills Stadium, 1200 Lakeland Drive, Jackson
  • Admission: Free

The City of Jackson is hosting its Fireworks Extravaganza starting at 5 p.m. Wednesday, July 1, at Smith Wills Stadium.

Before the fireworks, guests can enjoy local food vendors and live entertainment. The event also will include a kid zone with water slides, bounce houses, face painting and games.

Independence Celebration at The Rez

  • When: Saturday, June 27, 5-9 p.m.
  • Where: Bobby Cleveland Park at Lakeshore and Old Trace Park
  • Admission: Free

Celebrate Independence Day Rez-style at the Ross Barnett Reservoir. The event takes place the Saturday before the Fourth of July at Bobby Cleveland Park at Lakeshore and Old Trace Park.

Live music, kid zones, food vendors and beer will be on hand. Fireworks begin at 9 p.m. No outside coolers are allowed.

Freedom Fest

  • When: 6 to 10 p.m., Friday, July 3
  • Where: Brandon Amphitheater, 8190 Rock Way, Brandon
  • Admission: Free

Brandon’s complimentary Freedom Fest will be a kick-off to the holiday weekend celebrations. The event will include inflatables for the kids, a Cornhole tournament, face painting, food trucks and will close with a patriotic concert and fireworks display.

Red, White and Blue Fest

  • When: 4 p.m., Saturday, July 4
  • Where: Soccer Row, Traceway Park, Clinton
  • Admission: Free

The 36th annual Red, White and Blue Fest in Clinton starts at 4 p.m. on Saturday, July 4.

Local live music, food and games lead up to the fireworks finale at 9 p.m. Live music performances include blues prodigy John Clayton White at 5:30 p.m. and The Fountain City Players at 7:15 p.m.

Brian Broom has been reporting on and photographing Mississippi for more than 35 years. He can be reached at 601-961-7225 or bbroom@gannett.com.

Advertisement



Source link

Continue Reading
Advertisement

Trending