News Briefs

Ohio Attorney General Dave Yost (R) revealed in a March 11 press release that the state is suing Centene Corp. “for an elaborate scheme to maximize company profits at the expense of the Ohio Department of Medicaid (ODM).” The lawsuit alleges that Centene’s subsidiary Buckeye Health Plan used “a web of subcontractors for the provision of pharmacy benefits in order to misrepresent pharmacy costs, resulting in millions of dollars of overpayments by ODM.” In a statement, Centene responded that the state’s “claims are unfounded, and Envolve will aggressively defend the integrity of the pharmacy services provided to the State of Ohio.” As part of a larger effort to overhaul its Medicaid managed care program, Ohio in January announced that in 2022 it will replace a host of PBMs contracted by Medicaid managed care organization — including Centene’s Envolve Pharmacy Solutions — with just one PBM, Gainwell Technologies. Read more at https://bit.ly/3exKtpa.

Cigna Corp. will now offer Medicare Advantage (MA) members in 11 states who have chronic kidney disease (CKD) and end-stage renal disease (ESRD) in-home kidney care management from Monogram Health, a renal care startup. The new states include “most of Florida,” along with Texas, Pennsylvania, Illinois, North Carolina, South Carolina, New Jersey, Delaware, Maryland, Missouri, Kansas and Colorado, plus the District of Columbia. The benefit was previously available to individual MA customers in Arkansas, Arizona, Alabama/North Florida, Mississippi, Tennessee and Georgia. According to the press release, “Monogram’s care management staff of nurse case managers and social workers regularly visit CKD and ESRD patients in their homes [and]…develop personalized care plans aimed at keeping customers with kidney disease healthy and out of the hospital. Care management strategies include medication therapy management, co-morbidity management and collaboration with nephrologists and primary care physicians on evidence-based renal care pathways…[and] addressing patients’ social determinants of health.” Visit http://prn.to/30A1E11.

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AIS Health Staff

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