Alleged Drug Overcharging Scheme Spawns 10 Lawsuits

Employee Benefits News examines legal developments that impact the employee benefits and executive compensation employers provide, including federal and state legislation, rules from federal...

By Jacklyn Wille

Dec. 9 — Accusations of a prescription drug overcharging scheme involving some of the country’s largest pharmacy benefit managers and health insurers have spawned 10 proposed class actions in the past two months.

Taken together, the lawsuits claim that PBMs OptumRx and Humana Pharmacy Solutions Inc. worked with health insurers to overcharge patients for prescription drugs. The most recent complaints were filed on Dec. 7 and Dec. 8 against Cigna and UnitedHealth, respectively. According to the lawsuits, when a given prescription drug costs less than a patient’s copayment amount, insurers including United Healthcare, Cigna and Humana “claw back” the difference through an improper scheme kept hidden from patients ( Davis v. OptumRx, Inc. , C.D. Cal., No. 8:16-cv-02165, complaint filed 12/7/16 ; Mastra v. UnitedHealth Grp., Inc. , D. Minn., No. 0:16-cv-04119, complaint filed 12/8/16 ).

Since Oct. 4, at least 10 lawsuits have been filed challenging this alleged scheme. The recent complaint against UnitedHealth claims that “tens of thousands” of people have been affected, while the Cigna lawsuit places the number in the “hundreds of thousands.”

Many of the lawsuits cite an investigation into health insurance clawbacks that New Orleans television station Fox 8 began airing in May. The investigation found that some insured patients may be paying more for prescription drugs than they would if they lacked insurance altogether.

The Dec. 7 lawsuit against Cigna and OptumRx was filed by Whatley Kallas LLP, Steel Wright Gray & Hutchinson PLLC and Mauriello Law Firm. This legal team also filed a lawsuit against OptumRX and UnitedHealth on Nov. 23.

The Dec. 8 suit against UnitedHealth was filed by Gustafson Gluek.

A representative for Cigna declined to comment on the lawsuit against it. UnitedHealth representatives didn’t immediately respond to requests for comment.

To contact the reporter on this story: Jacklyn Wille in Washington at

To contact the editor responsible for this story: Jo-el J. Meyer at

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