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Centene and the settlement saga

A December 7 article in Fierce Healthcare reports that Centene will settle yet another pharmacy benefit management case.

“Centene” and “settlement” are two words that have come up so many times this year, we can’t even count. And it’s not stopping yet.

Another million-dollar settlement is on the table for Centene in Kansas, where, according to an article in Fierce Healthcare, Centene has agreed to pay $27.6 million to the state after an investigation into its pharmacy benefit manager (PBM) services.

After Ohio started looking into overbilling by PBMs, Kansas said, hey, wait a minute, and began an investigation of its own. The investigation into Centene’s PBM was essentially a ripple effect from the case in Ohio (and don’t forget the other case in Mississippi, too!).

And it’s no surprise to us that the result of the years-long investigation has resulted in another million-dollar settlement for the embattled PBM.

The investigation revealed “failures on the part of Centene to accurately report pharmacy expenditures to state regulators.” It also found that Centene used “opaque” reporting that made it difficult for the state to vet claims.

And how does Centene react after all these settlements? By getting out of the PBM biz.

That’s right. According to Axios, Centene not only “failed to manage drug spending in-house,” but now it’s also poised to make a pretty penny selling its business to the highest bidder.

Seems like for payors, even when you lose, you win.

Now, advocates are increasingly starting to call out profiteering-like behavior from PBMs. For an example, check out this campaign from the National Community Pharmacists Association, appropriately titled “The Truth.”

We’ll leave the profiteering claims for the experts to decide, but all we know is that patients certainly don’t benefit when a company sets aside $1 billion to settle against years of bad behavior, and then turns around and cashes in on the profits.

Original Article:

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