Express Scripts must pay $3.2 million to the Massachusetts Attorney General’s Office for allegedly overcharging people for prescriptions tied to their workers’ compensation claims.
Following an investigation, the AG claimed Express Scripts, “billed and obtained payment for prescription drugs from payers of workers’ compensation claims in excess of amounts permitted by Massachusetts laws and regulations,” according to court documents.
Express Scripts, a pharmacy benefit manager that negotiates drug prices, allegedly overcharged for prescription drugs at several pharmacies, including CVS, Walgreens, Rite Aid and others. This took place throughout Massachusetts, including in: Springfield, Boston, Fall River, and Worcester.
The company agreed to pay the AG’s office within the next 10 days, according to a signed agreement between Express Scripts Executive Vice President Nicole Jones and Massachusetts Assistant AG Glenn Kaplan. Express Scripts may be paying but “without admitting any facts, liability or any wrongdoing,” according to court documents.
The funds will be used for education, consumer outreach, and support for public interest programs and efforts regarding workers’ compensation insurance.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
There were few public details in the case. Express Scripts said in court documents that information provided to the AG “constitute confidential commercial and trade secret information.”
Express Scripts did not immediately respond to a request for comment.
Cigna acquired Express Scripts in 2018, making it one of the vertically integrated health insurance companies that also operates a pharmacy benefit manager.
The $67 billion acquisition would improve patient affordability, Cigna said at the time in a statement reported by Fierce Healthcare. “Together, we are establishing a blueprint for personalized, whole person health care, further enhancing our ability to put the customer at the center of all we do by creating a flexible, open and connected model that improves affordability, choice and predictability,” the company said in 2018 upon announcing the acquisition.
Large pharmacy benefit management companies have recently come under increased scrutiny. The Federal Trade Commission announced in June it was investigating PBMs, including Express Scripts.
Photo: Irina_Strelnikova, Getty Images
