Skip to main content
Sister Publication Links
  • ESG: THE NEW IMPERATIVE
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Digital Health
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Supply Chain
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • MORE +
    • Contact Us
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Legal
June 21, 2022 02:58 PM

Express Scripts' 'refill pill mill' bilked government, suit alleges

Alex Kacik
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    gavel-legal1_i.png
    MH Illustration

    Express Scripts delivered unnecessary prescription drugs to military personnel, bilking the federal government and vendors out of billions of dollars, a whistleblower alleges in a False Claims Act lawsuit.

    The St. Louis-based pharmacy benefit manager allegedly enrolled as many Tricare beneficiaries as possible in automatic delivery, which was set up to provide an extra nine-month supply of drugs over the course of a year, according to a qui tam lawsuit filed in a California federal court in mid-2019 and unsealed Friday. Express Scripts inflated drug costs for payers and patients through its "refill pill mill" that systematically overcharged the military's health insurance program for unnecessary medication from October 2009 to March 2018, the suit alleges.

    The former pharmacist in charge of Express Scripts' mail order pharmacy in Tempe, Arizona, seeks damages on behalf of the federal government and for the company to stop its alleged fraud. The government hasn't decided whether to intervene, according to court filings.

    "Express Scripts hid its conduct from (the U.S. Defense Department) and Tricare, causing the United States to purchase additional pharmaceutical products to replenish its prescription drug supply. Consequently, the United States paid Express Scripts and other vendors billions of dollars in excessive dispensing fees and drug-replacement costs," the complaint alleges.

    Express Scripts, which merged with the insurer Cigna Corp. in 2018, did not reply to requests for comment. The law firm representing the whistleblower, Constantine Cannon, declined to comment.

    Express Scripts' software was allegedly set to refill 90-day prescriptions on day 60, meaning that each Tricare beneficiary received 73% more pills than prescribed over the course of a year. The "scheme" is indicative of a systemic problem among PBMs that over-dispense prescription drugs through automatic refills, the suit alleges.

    Multiple patients complained about Express Scripts to the government, saying the company allegedly sent refills too often and would not honor requests to stop, according to complaints submitted online in 2016, 2017 and 2018 and included in the suit. One Tricare beneficiary wrote in May 2016 that she "hates this company and cannot believe that military members are forced to use them for maintenance medications. Their actions are at best negligent and at worst criminal."

    The Defense Department has contracted with Express Scripts since 2003 to provide retail, mail-order and specialty pharmacy services to approximately 10 million Tricare beneficiaries, the complaint alleges. The company is paid an administrative fee of approximately $17 for each prescription dispensed, the lawsuit alleges. In 2017 alone, Express Scripts dispensed nearly 120 million prescriptions to Tricare beneficiaries, the complaint alleges

    The Federal Trade Commission initiated an investigation into PBMs earlier this month. The agency required the six largest PBMs, including Express Scripts, to provide information about their activities as regulators inquire about how vertical integration in the PBM sector affects access and pricing in the prescription drug market.

    CVS Health's CVS Caremark, Cigna's Express Scripts and UnitedHealth Group's OptumRx collectively control about 80% of the PBM market, the FTC said.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Surprise Billing2.jpg
    Providers score another win in surprise billing litigation
    drugs_money
    Drugmakers restrict 340B sales after appellate court ruling
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Daily Dose Newsletter: Sign up to receive a late afternoon weekday roundup of that day’s breaking news and developments in healthcare.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Digital Health
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Supply Chain
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • MORE +
      • Contact Us
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing