Firm Settles Claims It Overcharged for New Bedford Prescriptions

NEW BEDFORD — A pharmacy benefits managing company has agreed to pay a $5.8 million settlement for allegedly failing to follow proper prescription pricing at pharmacies in several Massachusetts locations, including in New Bedford.

The state Attorney General's office announced the settlement with the California-based Optum Rx, Inc. on Thursday.

According to the A.G.'s office, the company allegedly failed to follow prescription pricing rules, such as the Federal Upper Limit for Medicare and the state's Maximum Allowable Cost, for certain workers' compensation insurance drug charges.

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The rules were put in place to keep costs down and prevent overcharging in the workers’ compensation insurance system, according to the office.

At issue are the charges for various injured worker prescriptions filled at Walgreens, CVS, and RiteAid in Springfield, New Bedford, Boston and Worcester.

Massachusetts' workers compensation covers certain medical costs for workers injured on the job, including some prescriptions.

Optum Rx pays pharmacies that fill prescriptions for patients, then charges insurers for those drugs under the workers’ comp insurance system, the A.G.'s office noted.

The office alleged that by failing to follow regulations, Optum Rx may have allowed excessive drug costs into the system, potentially resulting in higher premiums for all.

“Our workers’ compensation insurance system has specific processes in place to help ensure drug pricing is handled fairly, maintains transparency, and keeps costs down,” Attorney General Maura Healey said. “Our investigation found that Optum Rx drove up costs in the system, which can increase premiums for small business owners across the state."

"This settlement ensures that Optum Rx does not unlawfully profit and follows the rules going forward,” she added.

In a statement, Optum noted that while the company disagrees with Healey's interpretation of the workers' compensation fee rules, "we are pleased to resolve these issues and look forward to continuing to support our clients and the pharmacy needs of the workers of Massachusetts.”

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