Express Scripts settling for $3.2 million in prescription drug prices case

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Pharmacy benefit manager Express Scripts, which had been taken to a Massachusetts court for allegedly overcharging for some injured workers’ prescriptions, has now settled the case for $3.2 million, according to a court document filed this week.

The case had been brought by the state’s Attorney General’s Office, which alleged that Express Scripts billed and was paid for prescription drugs from payers of workers’ compensation claims in amounts that exceeded what is outlined in state law.

“These alleged overcharges occurred on prescription drugs provided by pharmacies to workers’ compensation insurance beneficiaries who utilized CVS, Walgreens, Rite Aid and other pharmacies in various MA locations such as: Springfield, Boston, Fall River, and Worcester,” according to the court document.

AG Maura Healey, who was elected Massachusetts governor on Tuesday, added that Express Scripts coordinated with her office’s investigation, though it did not admit any liability or wrongdoing.

WHAT’S THE IMPACT

To ensure Express Scripts adheres to state law, the agreement stipulates that the PBM will develop a Compliance Pricing Protocol, outlined in a separate agreement between Express Scripts and the AGO. The Protocol is subject to change as necessary as the laws and regulations may change regarding prescription drugs covered by workers’ compensation insurance.

If the PBM is paid by a pharmacy and a pharmacy review determines it previously overcharged Express Scripts for workers’ compensation-related drugs, the court agreement stipulates that Express Scripts notify the AG’s office of the payment and provide copies of all claims information and correspondence.

The $3.2 million settlement may be used by the AGO “for education, consumer outreach, amelioration of consumer harm, and/or support for public interest programs and efforts regarding workers’ compensation insurance, work-place injury prevention, rehabilitation, and prescription choices and management,” according to the settlement.

A portion may also go into the state Treasury’s General Fund, Healey said.

THE LARGER TREND

The Federal Trade Commission earlier this year required the six largest pharmacy benefit managers – Express Scripts among them – to provide information and records regarding their business practices. The agency launched an inquiry into what it called the prescription drug middleman industry to scrutinize the impact of vertically integrated pharmacy benefit managers on the access and affordability of prescription drugs. 

In addition to Express Scripts, the FTC sent compulsory orders to CVS Caremark, OptumRx, Humana, Prime Therapeutics and MedImpact Healthcare Systems.

“Although many people have never heard of pharmacy benefit managers, these powerful middlemen have enormous influence over the U.S. prescription drug system,” said FTC Chair Lina M. Khan in June. “This study will shine a light on these companies’ practices and their impact on pharmacies, payers, doctors, and patients.”
 

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