HAHNVILLE – The Louisiana attorney who is leading a class-action lawsuit against United Healthcare alleging unfair business practices says the insurance company’s tactics are commonplace in the industry.
At issue is a pharmacy card issued by Optum, United HealthCare’s pharmacy benefit manager, which is supposed to give customers discounts on prescription drug purchases. But, according to a complaint filed by Hahnville-based attorney Andrew Lemmon of the Lemmon Law Firm, it didn’t.
In fact, the complaint alleges that when the drug being purchased was less expensive than the normal copay cost, the company kept the difference – an amount Lemmon said could ultimately amount to tens of millions of dollars taken from unwitting consumers.
It’s a practice that those in the pharmaceutical insurance industry call “clawback,” and Lemmon said it’s so unseemly that it’s hidden from customers on purpose – with the contracts that insurers sign with pharmacies for premium drug prices restricting the pharmacies from even disclosing the practice to their own customers.
“In real simple English, if someone had a $50 copay and the prescription only cost $10, Optum would claw back the $40 difference from the pharmacy,” Lemmon told the Louisiana Record. “It’s fairly common in the industry. A lot of the big ones do it.”
Lemmon said several pharmacy trade associations have spoken out against the practice under the argument that consumers were being deceived.
“They are getting an additional premium or kickback from the pharmacy,” he said. “It’s a hidden premium, on top of the premium that’s already been paid when you bought your insurance, and the consumer isn’t even told about it.”
Lemmon said while there are no specific laws that ban the clawback practice, the fact that consumers are not informed of the additional premium is proof that it is unfair and should be prohibited. The suit, which the attorney assumes will receive class-action approval, seeks not only reimbursement of customers’ overpaid copays, but asks for the company to cease the practice altogether.
“Some people may have lost just $10 because of what (United was) doing, but that ends up being a lot of money when you consider the number of customers who could have been affected,” he said. “Getting them to stop this is part of the goal.”
Lemmon said he became suspicious that something was amiss and started investigating the pharmacy cards after he started noticing copay discrepancies between two different benefit cards in his own insurance prescription program. After seeing investigative reports of the copay practice on a local television news program, “I just kept digging,” he said.
As for a lawsuit, Lemmon said he is still in the early stages of preparation. He would not estimate how many customers of United HealthCare may have been affected, but noted the company offered tens of millions of prescription cards. He said the suit is being filed in Minnesota court because that is where the company’s headquarters is based.
“It’s a huge undertaking and we’re just getting started,” he said.