Express Scripts, a pharmacy-benefits-management company, has agreed to pay $9.5 million to 28 states and the District of Columbia to settle allegations that the company engaged in deceptive prescription-switching practices that had no financial or health benefits for patients.
Under the terms of the agreement, St. Louis-based Express Scripts admitted no wrongdoing, but agreed to pay in order to avoid litigation.
“This wasn’t a lawsuit,” said Express Scripts spokesman Steve Littlejohn. “It was an investigation that had been under way since July 2004, and the settlement allows us to move forward and bring this to an end in a way that’s acceptable to the attorneys general. It also precludes future litigation. We obviously don’t agree with the claims the AG made, but will make some minor adjustments to some of our procedures.”
The investigation probed whether Express Scripts switched patients to brand-name cholesterol drugs in an effort to maximize volume rebates the company received from drug manufacturers. Patients were often told they would benefit by the switch, but in fact incurred some expenses related to the changes, according to a news release from the Pennsylvania attorney general’s office.
Express Scripts also agreed to change several of its former prescription-switching practices. According to the agreement, the pharmacy-benefits-management company can no longer solicit patient drug switches if the cost of the proposed drug exceeds the cost of the original drug; if the original drug has a generic equivalent but the proposed drug does not; if the original drug’s patent will expire in six months; or if a the patient was switched from a similar drug within the last two years.
The settlement also requires Express Scripts to disclose any financial incentive it may have for soliciting a prescription switch and to reimburse patients for related costs. Although it agreed to the disclosure rules, Express Scripts in a company news release maintained that its previous disclosures practices had been “forthright and adequate.”
Arizona, Arkansas, California, Connecticut, Delaware, the District of Columbia, Florida, Illinois, Iowa, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nevada, New Mexico, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia and Washington participated in the settlement.
The Express Scripts agreement follows earlier settlements by two other major pharmacy-benefits-management companies, Medco Health Solutions and CVS Caremark Corp., with those states. -- by Shawn Rhea
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