Idaho AG Announces Idaho’s Participation in $ 75 Million Settlement with Bristol-Myers Squibb Over Allegations of State Medicaid Programs Overload | Idaho

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BOISE – On Tuesday, September 7, Idaho Attorney General Lawrence Wasden announced that Idaho had joined with other states and the federal government in addressing allegations that the Bristol-Myers Squibb company had overcharged state Medicaid programs for drugs. The investigation resulted from a qui tam action filed in the United States District Court for the Eastern District of Pennsylvania under the Federal Misrepresentation Act and various state misrepresentation laws.

Bristol-Myers Squibb, a New York-based pharmaceutical maker, paid states and the federal government $ 75 million to resolve allegations against the company.

As per the settlement, Idaho received $ 86,102 in payment on September 7, 2021. Of that amount, $ 42,809 will go to the Department of Health and Welfare for the state’s return of Medicaid. The rest will go to the general state fund.

Specifically, these settlements resolve allegations that Bristol-Myers Squibb underpaid drug reimbursements owed to states. Under a federal law known as the Medicaid Drug Rebate Program, drug manufacturers are required to periodically return a portion of the amount paid by state Medicaid programs for manufacturer drugs. The rebate program is designed to ensure that states pay competitive prices for drugs, and rebates for a manufacturer’s drugs are calculated based on a percentage of the average prices that wholesalers pay for each drug. This average price, which the manufacturer reports to the federal government, is known as the Manufacturer’s Average Price, or AMP. The higher the AMP declared by the manufacturer, the higher the rebate the manufacturer must pay for that drug.

The whistleblower complaint alleged that Bristol-Myers Squibb erroneously treated certain fees paid to wholesalers as rebates, and erroneously failed to include certain price appreciation amounts it received from wholesalers in its SAP calculations , and that the effect of these accounting practices was to distort AMP companies reported to the federal government and unduly diminish rebates paid to states. Claims resolved by settlement are only allegations; there was no determination of responsibility.

A team from the National Association of Medicaid Fraud Control Units (NAMFCU) participated in the investigation and conducted settlement negotiations with Bristol-Myers Squibb on behalf of the states and included representatives from the offices of the state attorneys general of California, from Florida, New York York, North Carolina and Texas.

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