PBM Clawbacks Exposed in Minnesota and Louisiana
Another local TV station has investigated PBM clawbacks and how gag clauses forbid pharmacists from telling patients about insurance overcharges and less expensive alternatives. Reporter Jay Olstad of KARE 11 in Minneapolis aired his segment last Friday. Among his interviews was NCPA CEO B. Douglas Hoey, Pharmacist, MBA, who said two of the most active PBMs in employing clawbacks were OptumRx and Catamaran, both owned by United Healthcare, headquartered in a Minneapolis suburb. Class action lawsuits have been filed against the United Healthcare and OptumRx over clawbacks. The United Healthcare declined to comment on camera to KARE 11.
An attorney involved in one of the clawback lawsuits told the Louisiana Record Nov. 4 that the practice is “so unseemly that it’s hidden from customers on purpose—with the contracts that insurers sign with pharmacies for premium drug prices restricting the pharmacies from even disclosing the practice to their own customers.”
Hahnville, La.-based attorney Andrew Lemmon of the Lemmon Law Firm, further explained: “In real simple English, if someone had a $50 copay and the prescription only cost $10, Optum would claw back the $40 difference from the pharmacy. It’s fairly common in the industry. A lot of the big ones do it.”
Filed under: General Problems
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