понедельник, 12 сентября 2011 г.

Omnicare Takes Legal Action Against Health Insurers, PBMs

Omnicare, a Kentucky-based prescription drug and medical services supplier for nursing homes, has filed civil lawsuits or has begun arbitration hearings in multiple locations nationwide against 16 health insurers and pharmacy benefit managers to obtain $61 million allegedly owed by the companies, the Cincinnati Enquirer reports. According to a letter to Omnicare employees from general counsel Mark Kobasuk obtained by the Enquirer, because of "inaccurate data and programming issues" in both the federal government and Medicare prescription drug plans operated by the companies, Omnicare has incurred "inappropriate" copayments and rejected reimbursement claims.

Omnicare has incurred $27 million in inappropriate copays and $34 million in rejected reimbursement claims as of March 31, according to the letter. The letter did not specify the dollar amounts that Omnicare seeks from the individual companies -- which include Aetna, Argus Health Systems, Blue Cross Blue Shield of Michigan, CVS Caremark, Cigna, Coventry Health Care, Express Scripts, FLRx, Medco Health Solutions, MedImpact, PharmaCare, Prime Therapeutics, RxSolutions, Sierra Health Plans, WellPoint, and the Ovations and WellCare Medicare prescription drug plans administered by Walgreens Health Initiatives.

Omnicare CEO Joel Gemunder on Tuesday said, "Though CMS ... has acknowledged the debt owed to long-term pharmacies and instructed the prescription drug plans to reconcile and pay these amounts, action here has been very limited." He added that "we are stepping up our efforts with both CMS and prescription drug plans utilizing all means available ... to address these issues and collect the money that is owed to us" (McNair, Cincinnati Enquirer, 6/29).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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