By Samantha Young | Kaiser Health News
Centene Corp. has agreed to pay more than $215 million to California over allegations it overcharged the state for pharmacy services — the biggest payout to date by the nation’s largest Medicaid insurer over its drug pricing practices.
The agreement announced Wednesday makes California at least the 17th state to settle pharmacy billing claims totaling $939 million with the St. Louis-based insurance giant. Centene reported $144.5 billion in revenue in 2022, up 15% from the previous year.
Investigators with the state Department of Justice found that Centene’s subsidiaries reported inflated drug costs and fees in providing prescription drugs to patients in Medi-Cal, the state’s Medicaid insurance program for people with low incomes and disabilities, from January 2017 to December 2018.
“When companies overcharge the Medi-Cal system, it drains valuable resources from the people who rely on this care,” Attorney General Rob Bonta, a Democrat, said in a statement.
As it has in previous settlements, Centene denied wrongdoing. Within California, the insurer operates two subsidiaries: California Health & Wellness and Health Net, which together provide coverage to around 2 million Medi-Cal patients statewide.
“This no-fault agreement reflects the significance we place on addressing their concerns and our ongoing commitment to making the delivery of healthcare local, simple and transparent,” Centene said in a statement emailed to KHN.
Most states contract with private insurance companies such as Centene to cover people in their state Medicaid programs, which are jointly paid for by state and federal taxpayers. In many of those states, the insurance company also handles prescription medications through what is called a pharmacy benefit manager, or PBM, to get lower prices. Such benefit managers act as intermediaries between drugmakers and health insurers and also between health plans and pharmacies. Centene has provided…
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