OptumRx Weight-Loss Drug Claim Approvals Drive New Lawsuit (1)

OptumRx Inc. wrongly approved thousands of claims for weight-loss drugs and forced a health plan for operating engineers to incur more than $4.3 million in improper charges, fund trustees alleged in a new lawsuit.

The summary plan description for the Operating Engineers Local #49 Health & Welfare Fund explicitly excluded “medical or surgical treatment of obesity” from coverage with one narrow exception, the trustees said. Despite these clear terms, Optum approved and paid more than 3,600 claims for Wegovy, Zepbound, and other weight-loss drugs, which were then charged to the plan, according to a complaint filed Wednesday in the US ...