News Briefs

✦ Centene Corp. on June 14 said it reached no-fault agreements with the attorneys general of Ohio and Mississippi to resolve claims made by the states related to services provided by Envolve Pharmacy Solutions, Inc. The Ohio Dept. of Medicaid and the state in March accused Centene of violating its Medicaid contract by using a “web of subcontractors” to hide pharmacy information from ODM. Those subcontractors included Envolve, one of its pharmacy benefit manager subsidiaries, which will no longer serve as a PBM on behalf of Centene’s local health plans, according to the company. As a result of the settlement, Centene will pay $88 million to Ohio and $55 million to Mississippi; it did admit any liability for the pharmacy practices alleged by both states.

✦ Three Medicare Advantage insurers that challenged a temporary star ratings policy implemented by CMS last April lost their legal battle. In AvMed, Inc. et al v. Azar et al (No. 20-3385), filed Nov. 20, 2020, in the U.S. District Court for the District of Columbia, Florida-based AvMed and Nevada-based Prominence HealthFirst argued that CMS unlawfully changed the ratings in a way that unfairly penalized organizations when it issued an interim final rule suspending the collection of certain data. In an opinion issued June 1, U.S. District Court Judge John D. Bates sided with CMS, arguing that the agency’s “analytical path was clear” and that there’s no way to confirm that the plaintiffs’ ratings would have improved if not for the suspended data collection.

© 2024 MMIT
Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues, including drug benefits and specialty pharmacy, for more than a decade. She served as editor of Drug Benefit News (the predecessor to Radar on Drug Benefits) from 2004 to 2005 and again from 2011 to 2016, and now manages Radar on Medicare Advantage. Lauren graduated from Vassar College with a B.A. in English.

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