New Mexico AG settles with Centene over lack of price transparency
The state Attorney General's Office announced this week that it has reached a $13.8 million settlement with Centene Corp., which owns subsidiaries involved in the state's Medicaid program.
A news release from the AG's Office said Centene failed to pass on discounts to the state's Medicaid program, among other things. The Medicaid program is overseen by the state Human Services Department.
The Attorney General's Office said it had engaged in an "investigation of the company's subsidiaries' pricing and reporting of pharmacy benefits and services." The State Auditor's Office and the Human Services Department referred the case to the attorney general.
In a news release, Balderas said the investigation "was necessary to shine a light on industry practices, ensure greater accountability and return $13.7 [sic] million back to New Mexico."
A Centene spokesperson wrote in an email: "We respect the deep and critically important relationships we have with our state partners. This no-fault agreement reflects the significance we place on addressing their concerns and our ongoing commitment to making the delivery of healthcare local, simple and transparent. Importantly, this allows us to continue our relentless focus on delivering high-quality outcomes to our members."
In a no-fault agreement, the claimant — in this case, the state — doesn't have to establish fault by the other party to obtain compensation. Centene made no admission of liability in the agreement.
The settlement agreement includes assurances Centene will discontinue the practices in question and commit to price transparency in the pharmacy benefits and services provided to the Human Services Department.
The Attorney General's Office's investigation of Centene focused on concerns the company was layering fees and not passing on retail discounts to New Mexico's Medicaid program, also called Centennial Care, the news release said. Centennial Care provides health care services and medications to nearly 1 million people in New Mexico.
Among Centene's subsidiaries are Western Sky Community Care and Envolve Pharmacy Solutions.
Centene subsidiaries have provided pharmacy benefits and services to New Mexico's Medicaid program through an effort dubbed Centennial Care since 2019. Balderas said he and state Superintendent of Insurance Russell Toal will continue an investigation of pharmacy benefit managers.
Pharmacy benefit managers are third-party administrators contracted by health plans, employers, unions and government entities to manage prescription drug benefit programs.
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