Express Scripts accused of overcharging millions of dollars

July 21, 2020
Christine Blank

The PBM overcharged for generic drugs, among other offenses, a new lawsuit claims.

In a new lawsuit, the State of Ohio claims PBM Express Scripts overcharged the state millions of dollars for services it didn’t deliver.

According to the complaint, Ohio Attorney General Dave Yost said Express Scripts misclassified generic drugs as brand drugs in order to charge higher prices, failed to meet the pricing discount and dispensing fee guarantees, and overcharging for generic drugs by failing to timely adjust generic pricing lists to accurately reflect the lowest available pricing.

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“This particular PBM egregiously charged for services it didn’t deliver. Its repeated breaches cost Ohioans millions, and we want our money back,” Yost said in a press release.

“It’s no secret that PBMs have been keeping secret their prescription pricing in order to evade public scrutiny and rake in revenue,” Yost added. “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 complaint was filed on behalf of the Ohio Highway Patrol Retirement System (HPRS). In each year of its contract with HPRS except 2011-12, Express Scripts failed to satisfy the pricing guarantees in the then-applicable pricing schedule, thereby overcharging HPRS on thousands of claims, according to Yost.

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The lawsuit alleges 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 also filed a complaint against OptumRx last year, alleging that the PBM overcharged the Bureau of Workers’ Compensation $16 million. That case awaits a judge’s ruling on several key motions.

Read more: Express Scripts reveals Medicare savings plan for 2020

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