The Mississippi Board of Pharmacy completed an audit of Optum’s 2022 commercial claims, identifying several potential violations of state law.
Among the apparent violations, more than 75,000 claims were reimbursed at higher rates to PBM-owned or affiliated pharmacies during the study period. In reviewing the 49 MAC lists used by Optum, 22 were exclusive to chain pharmacies, and 15 were specific to independent pharmacies.
Within these lists, the board found the average independent MAC rates were 74 percent less than those of chains, with 97.7 percent of generics on MAC lists for independents versus 88 percent for chains. Meanwhile, over 98 percent of MAC appeals were denied, many of which the board views as in conflict with statute.
NCPA will continue monitoring developments from the board, which next meets on Oct. 24—see its schedule here.
