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Health

Duquesne sues Highmark

| Wednesday, Aug. 3, 2011

Duquesne University says that Highmark Inc. has paid claims for contraceptives and Botox and otherwise mishandled its prescription drug plan for the past three years, costing the Catholic school an extra $1.75 million.

The university filed a lawsuit on Tuesday in Allegheny County Common Pleas Court seeking to recover the amount of money it says it overpaid between July 2007 and July 2010.

Bridget Fare, spokeswoman for the university, said Duquesne filed the lawsuit to get Highmark to comply with its contract.

"We've been trying to resolve this for nearly two years," she said.

The university has documented at least $1.75 million in overpayments, but Highmark has refused to turn over all the documentation it needs to set an exact amount, Fare said.

A Highmark spokesman declined comment.

Duquesne, which is self-insured, hired Highmark in 2004 to handle its health insurance claims. Under the contract, Highmark wasn't supposed to directly handle the prescription drug claims but, rather, send them to another company, Caremark PSCHealth LLC.

Highmark violated the contract by directly processing some of the drug claims and sending others to its subsidiary, Medmark, the lawsuit says. Since Medmark didn't collect the monthly co-payments of up to $50 for some of the drugs, that increased the university's prescription costs, according to the lawsuit.

Highmark also approved drugs purchased from the Hemophilia Center of Western Pennsylvania, which increased Duquesne's prescription drug costs.

The contract specified that the university wouldn't pay for drugs that conflict with the Catholic faith, such as contraceptives, but Highmark approved payments for those drugs. Highmark and Medmark also approved payments for drugs that the university excluded from coverage for technical reasons, Fare said.

Those drugs included immune globulin and Infliximab, which are used to treat autoimmune disease such as HIV, although that wasn't the reason they were excluded from coverage, she said.

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