Centene to pay $13.7M to settle New Mexico pricing investigation

Centene has agreed to pay $13.7 million to settle an investigation into its subsidiaries' pricing and reporting of pharmacy benefits and services to New Mexico's Medicaid program.   

The payer's wholly owned subsidiaries were being investigated over concerns they were layering fees and not passing retail discounts on to the state's Medicaid program, the New Mexico attorney general's office said in a June 13 news release. 

Western Sky Community Care and Envolve Pharmacy Solutions are among Centene's New Mexico subsidiaries, according to the Sante Fe New Mexican.

As part of the agreement, Centene has agreed to provide complete pricing transparency on all  pharmaceutical benefits and services provided to the Medicaid program, according to the release. 

Centene's subsidiaries have provided pharmacy benefits and services to the state's Medicaid program since 2019. 

Since the start of 2021, Centene has settled with nine other states over allegations it overbilled Medicaid programs for prescription drugs and services through its pharmacy benefits arm, Envolve. The payer settled with Arkansas, Illinois, Kansas, Mississippi, New Hampshire and Ohio, along with three other states not identified.

Centene created a legal settlement reserve of $1.25 billion for those settlements and any future lawsuits, according to a 2021 Securities and Exchange Commission report. In public statements, the company has denied wrongdoing.

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