UnitedHealth, Others Knocked with Class Action Over Copay 'Clawbacks'

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UnitedHealth Group Incorporated and several other defendants are facing two proposed class actions out of Minnesota claiming the companies violated federal RICO laws by engaging in a “clawback” scheme that unlawfully collected patients’ excess payments from prescription drug transactions. As a result of the arrangement between the defendants and pharmacies, the lawsuit alleges, patients unknowingly paid amounts for prescription drugs that were often significantly in excess of the actual price of the medications.

Insurers contractually require pharmacies they work with to collect copayments from patients. “Clawbacks,” the complaints say, occur when health insurers collect the portion of a patient’s copayment – or coinsurance – that exceeds the cost of the prescription drug purchased at a pharmacy. “In other words,” one lawsuit says, “the clawback is the difference between the prescription drugs’ retail costs, or the price the class member would pay without insurance, and the amount that the class member is required to pay pursuant to his or her insurance policy.”

Along with United HealthCare Services, Inc., United HealthCare, Inc. Optum, Inc. and OptumRX, UnitedHealth allegedly applied clawbacks on “widely used, low-cost” generic drugs to impose patients’ deductible cost, copayments and coinsurance costs that were higher than the cost of the drugs. By doing this, the lawsuit firmly claims, the defendants undermined the entire pharmaceutical delivery system at the expense of patients.

“As a result, consumer believe that they are saving money through the use of their pharmacy benefit, when, in reality, they are being charged an excessive amount for the prescription,” one complaint reads.