Ohio Attorney General Dave Yost filed a lawsuit against Express Scripts, a pharmacy benefit manager (PBM), for allegedly breaking multiple contracts that allowed the company to profit millions from overcharges to the state.
A PBM is a company that controls the drug benefit program for employers or health plans according to verywellhealth.com.
Yost is filing this lawsuit in the Franklin County Common Pleas Court on behalf of the Ohio Highway Patrol Retirement System (HPRS), according to the attorney general’s press release. This retirement system has been working with Express Scripts since 2010, and it is seeking to recover unspecified damages from the PBM.
The lawsuit filed Monday says Express Scripts did not satisfy the “pricing guarantees in the then-applicable pricing schedule, thereby overcharging HPRS on thousands of claims.” The only time the lawsuit says the PBM did not do this was from 2011 to 2012.
“This particular PBM egregiously charged for services it didn’t deliver,” Yost said. “Its repeated breaches cost Ohioans millions, and we want our money back.”
The attorney general alleges that Express Scripts violated its agreement with HPRS in the following ways:
- Failing to meet the pricing discount and dispensing fee guarantees.
- Misclassifying generic drugs as brand drugs in order to charge higher prices.
- Overcharging for generic drugs by failing to timely adjust generic pricing lists to accurately reflect the lowest available pricing.
- Failing to disclose its sources of remuneration received in connection with its performance of services for HPRS.
“Express Scripts also repeatedly misclassified and/or continued to classify generic drugs as brand drugs,” the complaint reads. “Based on the classification, defendant Express Scripts charged higher prices on each of them because the brand drug pricing methodology was applied, which carried with it a lower pricing guarantee.”
Furthermore, the lawsuit claims that “breaches were committed knowingly in bad faith and with the intent to deprive HPRS of the benefit of its bargain” and that “HPRS was regularly charged commercially unreasonable prices for generic drugs throughout the term of the agreement.”
Yost said that it is no secret that PBMs have kept secret their prescription pricing to avoid pubic security and continue to receive revenue.
“I intend to shed light on their business model and bring true transparency to the process – they need to answer the tough questions and repay what is owed,” the attorney general added.
– – –
Zachery Schmidt is the digital editor of Star News Digital Media. If you have any tips, email Zachery at [email protected]. Follow Zachery on Twitter @zacheryschmidt2.
