For Immediate Release
January 6, 2022
James T. Boffetti, Associate Attorney General
Director, Division of Legal Counsel
James.T.Boffetti@doj.nh.gov | 603-271-0302
New Hampshire Reaches $21.148 Million Settlement with Centene Regarding Provision of Pharmacy Benefit Services
Concord, NH – Attorney General John M. Formella announces that the State of New Hampshire has entered into a settlement agreement with Centene Corporation and its affiliates ("Centene") regarding Centene’s provision of pharmacy benefit services.
Centene and its affiliates Granite State Health Plan, Inc. and NH Healthy Families, Inc. are responsible for one of the three health plans associated with New Hampshire’s Medicaid Care Management Program. The Department of Health and Human Services ("DHHS") and the Department of Justice ("DOJ") began a review of Centene's provision of pharmacy benefit services after similar investigations in other states became public. The review focused on concerns regarding Centene’s practices related to the reporting of pharmacy benefit services costs in the Medicaid program, including the pricing of prescription drugs.
As part of the settlement agreement, Centene will pay the State of New Hampshire $21,148,822.13. The payment will be made in two equal annual installments – the first payment will be made within 45 days of the effective date of the settlement agreement and the second payment will be made within one year after the first payment. The settlement amount was determined based on a national formula that Centene has used to settle other similar cases. The settlement covers the period of January 1, 2016 through December 30, 2021 (the "settlement period").
During the course of this review, DHHS and DOJ concluded that Centene's inaccurate reporting of pharmacy benefit services costs, and the State's use of that data received from Centene, resulted in at least a $2.4 million negative financial impact to the State during the settlement period. In lieu of further review, investigation, and potential litigation, Centene and the State of New Hampshire have agreed to settle this matter in exchange for payment in the amount referenced above and the implementation and continuation of business practices that provide full transparency related to pharmacy benefit claims. The State made the decision to settle for the referenced amount because the State determined based on its projections that this amount, calculated according to the national formula used by Centene for similar cases, would be more than sufficient to cover the total financial damages incurred by the State during the settlement period.
In connection with the settlement, Attorney General Formella and DHHS Commissioner Lori Shibinette released the following statements:
"This settlement represents a significant recovery for New Hampshire taxpayers that adequately compensates the State for the financial harm it has suffered," said Attorney General Formella. "We appreciate Centene's willingness to engage with the State to resolve this matter quickly and fairly. While this settlement is significant, we will not fall victim to complacency and will continue to take action to protect the financial interests of the State and its taxpayers."
"We appreciate Centene fully cooperating in the State’s audit of their pharmacy benefit services," said Commissioner Shibinette. "The matter was resolved reasonably and to the benefit of Centene's clients and New Hampshire Medicaid beneficiaries."
DHHS and DOJ will continue to review and audit the Medicaid Care Management Program for compliance, including reviews and audits of New Hampshire’s other two Medicaid Care Management health plans.