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|Wednesday, March 9, 2020||
County Executive Joseph A. Griffo today announced that
the Medicaid formula,
lawsuit focuses on two majors areas:
Prescription-drug reimbursement under
Medicaid is set by formulas based on the maximum allowable cost established
for drugs. The maximum allowable cost for non-generic drugs is based on
wholesale costs determined from information provided by manufacturers.
The lawsuit also will allege that drug
manufacturers fail to comply with the Federal Medicaid Rebate Statute.
Drug makers sign a contract with the federal government and promise
to report their Best Prices for drugs and to pay rebates based on these Best
Prices. The suit will allege
that drug companies do not comply with these requirements, and instead they
overstate their Best Prices and otherwise do not abide their rebate
obligations. As a result, the county will contend,
end result of this is that taxpayers are forced to bear an unjust burden
because Medicaid makes its payments based on the inflated prices,” Griffo
said. “Because the system is broken, we have situations where the price
for which Medicaid is billed is substantially above the prices that an
average person pays at an
noted three examples where the prices paid through Medicaid were far in
excess of the retail prices charged in
· Metformin Hydrochloride (brand name Glucophage), for which Medicaid was billed about $286,000 in 2003 according to state Health Department figures, was 42% above retail price.
· Lorazepam (brand name Ativan), for which Medicaid was billed almost $92,000 in 2003 according to state Health Department figures, was between 66% and 72% above retail price, depending upon the dosage.
· Enalapril Maleate (brand name Vasotec), for which Medicaid was billed about $74,000 in 2003 according to state Health Department figures, was 63% above retail price.
“Multiply these three example of gouging by the hundreds of prescriptions filled by Medicaid recipients in Oneida County every year, and we have the potential to recover millions of dollars in damages,” Griffo said, adding that the suit Oneida County will be filing will include a claim under New York Social Services Law 145-b, which provides for mandatory treble damages.
suit, which will be filed in the
Griffo noted that other governments, including the States of Ohio, Connecticut, Texas, Pennsylvania and California, and in New York State, New York City and several other counties, have already initiated lawsuits against drug makers for similar actions.