Centene Settles With States Over Pharmacy Benefits Practice

“Centene took advantage of all of us who pay taxes to care for the most vulnerable Ohioans,” he said in a release Monday.

Mississippi’s attorney general and auditor investigated similar issues, though the state hadn’t sued Centene. They said in a news release that the settlement “resolves allegations of overpayments as a part of Mississippi’s Medicaid program.”

Centene, which is based in St. Louis, said it admitted no fault in the settlements and denies any liability for the practices that the states examined. The company said that the issues that the states focused on occurred “primarily during 2017 and 2018” and it has since restructured its pharmacy benefits operations.

Several states are investigating pharmacy-benefit managers’ disclosure and billing practices, generally focused on their Medicaid and state-employee plans. Pharmacy-benefit managers typically work for employers and health plans, managing drug benefits and negotiating pricing with pharmaceutical companies and drugstores. They often have many lines of business that involve state governments, including handling the drug benefits of state employees and working with managed-care companies that administer Medicaid benefits.

The stakes for Centene are particularly high in the Medicaid-related probes because managing Medicaid coverage is a core business for the company. Ohio had deferred a decision about whether Centene could participate in its new Medicaid contracts for 2022, due to the litigation. The settlement is “reopening the door for [Centene] to receive a contract award” in Ohio, wrote Scott Fidel, an analyst at Stephens Inc.

Centene said it was negotiating with two law firms, Liston & Deas and Cohen Milstein, that are working with other states “in an effort to bring final resolution to these concerns.” The company said its new $1.1 billion reserve is related to those talks.

Write to Anna Wilde Mathews at [email protected]