Mississippi Today
OptumRx sues Mississippi Board of Pharmacy, alleges due process violation
A lawsuit filed by a major pharmacy benefit manager in December alleges the Mississippi Board of Pharmacy violated the company’s right to due process by releasing the findings of an audit before determining any wrongdoing.
The audit’s findings, released by the Board of Pharmacy in October, indicate that OptumRx may have violated Mississippi law by paying independent pharmacies in Mississippi rates lower than chains and Optum-affiliated pharmacies for the same prescription drugs in 2022.
Mississippi law prohibits pharmacy benefit managers from reimbursing their affiliate pharmacies, or those they own, at higher rates than non-affiliate pharmacies for the same services.
OptumRx filed the complaint in Hinds County Chancery Court on Dec. 10, naming all seven Board of Pharmacy members and Executive Director Susan McCoy as defendants. The lawsuit asks the judge to rule that an independent hearing officer preside over the administrative hearing on the audit’s findings.
Administrative hearings can lead to disciplinary action by the Board of Pharmacy, including fines.
A “one-sided press release” issued by the Board of Pharmacy – a two-page document summarizing the 848-page audit completed by Ridgeland-based HORNE accounting firm – thwarted OptumRx’s right to a fair and impartial hearing and demonstrated the board’s bias against the company, said the lawsuit.
The press release did not note the company’s upcoming administrative hearing to determine whether it had violated Mississippi law or state that OptumRx disputes the board’s claims.
An administrative hearing on the alleged law violations was previously scheduled for Dec. 19 but has been delayed due to the lawsuit.
The board declined to provide an independent hearing officer to oversee the administrative proceedings or to remove the press release from their website. It said it would “entertain” the possibility of posting a rebuttal from OptumRx, according to the lawsuit.
OptumRx declined to comment on the lawsuit, but a spokesperson for the company previously told Mississippi Today that it has identified errors in the audit’s findings and methodology and submitted them to the Board of Pharmacy.
The Board of Pharmacy declined to comment on ongoing litigation or administrative hearing matters, and HORNE did not respond to Mississippi Today by the time this story published.
OptumRx argued that the audit’s methodology was unfair because it did not investigate the services provided by affiliated, chain and independent pharmacies and instead assumed that all pharmacies dispensing the same prescription drugs offer identical services.
“It is wholly inappropriate to assume parity of service offerings between different types of pharmacies, such as OptumRx’s affiliated (long-term care) pharmacy and retail pharmacy,” wrote the lawsuit.
The audit’s analysis of a generic drug used to treat bacterial infections alleged that an Optum-affiliated pharmacy was paid eight times more than the lowest-paid independent pharmacy on the same day. Chain and affiliate pharmacies were allegedly paid over 20 times as much as independent pharmacies for a generic drug used to treat stomach and esophagus problems.
The audit’s findings have already led to litigation against the company.
In November, Valley Drugs, Inc., a Water Valley pharmacy, filed a class action federal lawsuit against OptumRx and its parent company, UnitedHealth Group, seeking damages for alleged violations of Mississippi’s prescription drug reimbursement regulation and citing the audit’s findings.
OptumRx 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 brought in $32.4 billion in earnings.
OptumRx is the third-largest pharmacy benefit manager in the nation, representing 22% of the industry’s market share in 2023.
A Federal Trade Commission report in July found that in general, 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.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1815
Jan. 8, 1815
A U.S. Army unit that included Black and Choctaw soldiers helped defeat the British in the Battle of New Orleans.
While peace negotiations to end the War of 1812 were underway, the British carried out a raid in hopes of capturing New Orleans. After the British captured a gunboat flotilla, Maj. Gen. Andrew Jackson put the city under martial law.
Despite being outnumbered, the U.S. Army force of about 2,000 (including a battalion of free Black men, mostly refugees from Santo Domingo, and up to 60 Choctaw Indians) defeated the British.
After the victory, Andrew Jackson honored these soldiers of color with a proclamation: “I invited you to share in the perils and to divide the glory of your white countrymen. I expected much from you, for I was not uninformed of those qualities which must render you so formidable to an invading foe. I knew that you could endure hunger and thirst and all the hardships of war. I knew that you loved the land of your nativity, and that, like ourselves, you had to defend all that is most dear to man – But you surpass my hopes. I have found in you, united to these qualities, that noble enthusiasm which impels to great deeds.”
Prior to the battle, Jackson had promised Black soldiers pay, acres of property and freedom to those who were enslaved. That inspired James Roberts to fight as hard as he could in the Battle of New Orleans.
“In hope of freedom,” he said, “we would run through a troop and leap over a wall.”
Although Roberts would lose a finger and suffer a serious wound to the head, the pledge proved hollow for him, just as it was in the Revolutionary War when he had been promised freedom and instead was separated from his wife and children and sold for $1,500.
The memoir he self-published in 1858 is once again available for sale.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Photos: Lawmakers gavel in for 2025 Mississippi legislative session
The Mississippi Legislature returned to the State Capitol on Tuesday for the start of the legislative session in Jackson.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Billionaire Tommy Duff forms Republican PAC as he weighs gubernatorial run
Billionaire Tommy Duff, as he considers a run for Mississippi governor in 2027, has formed a political action committee to help elect Republicans to city and legislative offices this year, likely to increase his influence as a political powerbroker.
Jordan Russell, a longtime Republican operative who has led several federal and state campaigns, is director of the PAC, which was formed in December.
Russell told Mississippi Today in a statement that Duff founded the PAC to support conservative candidates and advance policies that promote “opportunities, freedom, faith-based values and prosperity across Mississippi.”
“We are planning a significant investment in multiple races in our state to ensure strong, conservative leadership at every level of government,” Russell said.
Duff, a Hattiesburg resident and the co-wealthiest Mississippian along with his brother Jim, has been involved in state politics for decades, but mostly behind the scenes as a megadonor and philanthropist. He recently finished an eight-year stint on the state Institutions of Higher Learning Board, first appointed by former Gov. Phil Bryant.
READ MORE: Will a Mississippi billionaire run for governor in the poorest state?
He’s travelled around the state in recent months meeting with political and business leaders, potentially laying the groundwork for a gubernatorial run. Duff also appeared at last year’s Neshoba County Fair and made the rounds at the state’s premiere political gathering.
Duff and his brother turned a small, struggling company into Southern Tire Mart, the nation’s largest truck tire dealer and retread manufacturer. They created Duff Capitol Investors, the largest privately held business in Mississippi, with ownership in more than 20 companies, including KLLM Transport, TL Wallace Construction and Southern Insurance Group.
Duff has recently said he’s still weighing a run for governor, but his creation of a PAC that could garner support from many down-ticket Republicans would appear to be a concrete step in that direction. Duff’s entrance into a gubernatorial race would likely cause numerous potential candidates — particularly those who have looked to him for large campaign donations — to wave off.
While statewide elections are still two years away, municipal elections will take place this year and several special legislative races will happen as well.
Rep. Charles Young, Jr., a Democrat from Meridian, died on December 19, and Rep. Andy Stepp, a Republican from Bruce, died on December 5. Sen. Jenifer Branning, a Republican from Philadelphia, was sworn into office yesterday for a seat on the Mississippi Supreme Court. Special elections will take place later this year to fill these vacancies.
A federal three-judge panel also ruled last year that the Legislature must create new state Senate and House maps with Black-majority districts and conduct special elections in 2025 under those newly created districts.
The court ordered legislators to create a majority-Black Senate district in the DeSoto County area in north Mississippi and one in the Hattiesburg area in south Mississippi. The panel also ruled the state must create a majority-Black House district in the Chickasaw County area in northeast Mississippi.
However, the Legislature will also have to tweak many districts in the state to accommodate for the new Black-majority maps. State officials in court filings have argued that the redrawing would affect a quarter of the state’s 174 legislative districts.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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