‘Where’s my prescription?’: California wants to revoke an OptumRx pharmacy license for prescribing lapses
The California Board of Pharmacy is seeking to revoke or suspend a pharmacy license held by OptumRx, which is one of the largest pharmacy benefit managers in the U.S., for a series of prescribing failures that allegedly jeopardized patient health.
The infractions, which occurred between 2016 and 2020, involved failures to refill prescriptions promptly; substituting a medicine without written consent; telling a patient his health insurer denied a refill due to cost; and dispensing a generic version of a drug with a costly co-pay when the customer had no co-pay for the brand version, according to the complaint, which was filed in August but shared online recently by the agency.
This marks the second time in recent years that the California Board of Pharmacy has sought to penalize the company for similar violations committed by the facility, which is located in Carlsbad, Ca. That step followed a series of citations that were issued in 2013 and 2014 for not following dispensing instructions and releasing health information, among other things, according to a 2016 complaint.
Over the years, the problems at the Carlsbad pharmacy have also caught the attention of pharmacy boards in at least five other states: Alabama (see here and here), Colorado, Hawaii (see here and here), Maine and South Carolina. Each board cited the infractions in California as justification for issuing warnings or fines. State pharmacy boards often look at infractions that occur in other states if a problematic facility serves their residents.
A hearing to review the accusations, which also were made against the pharmacist in charge at the Carlsbad facility, is scheduled for February 2022, according to a spokesman for the state board. Although OptumRx runs several pharmacies in the state, each OptumRx facility doing business in California is licensed separately by the board, which means other facilities are not affected by the legal action.
A spokesman for OptumRx, which is owned by UnitedHealth Group (UNH), the health insurer, wrote to say the company provides more than 5 million prescription drugs to people through home delivery every month and that safety and quality checks deliver a dispensing accuracy rate of more than 99%. He claimed this is more than 500 times accurate than retail pharmacies.
“We take all consumer complaints seriously… these allegations are without merit and we will defend ourselves.”
This latest enforcement effort by the California Board of Pharmacy comes amid increasing scrutiny of pharmacy benefit managers, which play various roles in the opaque pharmaceutical chains. The companies are best known for creating formularies, or lists of medicines for which coverage is provided by health insurers. Drug makers, meanwhile, pay rebates to win favorable formulary placement.
Some pharmacy benefit managers also operate online pharmacies to provide a form of one-stop shopping which health plans can promote to their beneficiaries. OptumRx, for instance, operates numerous facilities in different states across the U.S. as part of its pharmacy benefits management business.
To what extent the California Board of Pharmacy may penalize OptumRx, should it win its case, remains unclear, though. To resolve similar accusations made in 2016, OptumRx was publicly censured and ordered to pay a $7,930 fine to cover the costs of the investigation, although the company was allowed to use a payment plan. The company was also ordered to provide healthcare services, such as reduced-cost immunizations, as part of a community service program.
In recent years, the California Board of Pharmacy has also focused on pharmaceutical wholesalers, some of which have often been cited for improper oversight in handling prescription medicines that are classified as controlled substances, such as opioids.