AG Rutledge reaches $15.2 million settlement with Centene in PBM case

by Roby Brock ([email protected]) 641 views 

Arkansas Attorney General Leslie Rutledge announced Thursday (Sept. 30) a $15.2 million settlement with Centene Corp. and its subsidiaries, Arkansas Total Care, Inc., Centene Management Company, and Envolve Pharmacy Solutions, Inc.

The settlement will end Rutledge’s review of the company’s business practices and its Pharmacy Benefit Manager (PBM), Envolve. Rutledge has investigated allegations that Centene was using these companies to overcharge the state for medications in its Medicaid program.

Centene’s total settlement to the state is $15,228,318.72.

“I have successfully fought predatory pharmacy benefit managers in the nation’s highest Court, and I continue to hold these providers accountable for gouging Arkansans with unreasonably high costs for their prescriptions,” said Rutledge. “I will always fight to protect Arkansans, and this settlement with Centene is a big step in repairing the damage it did by taking advantage of Arkansans.”

Arkansas Medicaid had tasked Envolve to assist in managing its prescription drug program. Envolve subcontracted its responsibilities for the payment of pharmacies to CVS Caremark.

When Envolve reported to Arkansas Medicaid the costs paid to pharmacies for the drugs, Envolve reported inflated amounts of pharmacy costs by failing to disclose substantial discounts in ingredient costs and dispensing fees which Envolve received under the Envolve-CVS subcontract. This conduct by Envolve occurred in 2017 and 2018 and ended with termination of the Envolve-CVS subcontract.

Centene must pay $15,228,318.72 to the State of Arkansas in two installments within the next year and 45 days. Going forward, Centene has agreed to provide Arkansas with full transparency related to the adjudication and payment of all pharmacy benefit claims, including the exact amount paid to the pharmacy for each pharmaceutical claim.

Rutledge has been active in a watchdog role involving the PBM industry.

She successfully won a case at the U.S. Supreme Court to uphold an Arkansas law to regulate PBMs.