�
Cigna and Express Scripts have in agreement to a $27 1000000 settlement in a 2004 lawsuit by New York State accusatory Express Scripts of persuading physicians to switch prescriptions to drugs for which larger rebates could be obtained from manufacturers without informing patients of the change, the Hartford Courant reports. The state contracted with Cigna to insure its Empire Plan, which covered more than than one million active and retired state and local government workers and their dependents, and Cigna subcontracted with Express Scripts to oversee the dose plan benefit.
Express Scripts was supposed to negociate the lowest possible mary Leontyne Price from drugmakers for the plan and return whatsoever rebate obtained to the state. However, then-Attorney General Eliot Spitzer (D) alleged that the pharmacy benefit manager committed fraud by disguising the rebates as administrative or other fees and safekeeping them. He had sought as a great deal as $100 million in reimbursements, as well as penalties and fines. The suit also claimed Express Scripts hyperbolic the price of generic drugs for the plan (Levick, Hartford Courant, 7/30). "Sometimes they would turn over some of the rebate to the state, but a lot of the time they would just pocket the money," Alex Detrick, spokesperson for New York State Attorney General Andrew Cuomo (D), said (Blain, New York Daily News, 7/30).
Under the agreement, consumers served by Express Scripts or other PBMs subcontracting with Cigna will receive notice when a drug switch is initiated and will be informed of their right to deny the switch, Cuomo aforementioned. Express Scripts also will adopt new rules intended to make its practices more transparent to wellness organizations and consumers, including disclosing its pricing methods, the amount of payments received from drugmakers, the factors it considers when calculating targeted discount rates and the current discount rate for generics. The settlement money will be given to the Empire Plan. "The message is clear: companies that switch patients' drugs without making known them testament be prosecuted to the fullest," Cuomo said (Bray, Dow Jones, 7/29).
Cigna and Express Scripts did non admit any wrongdoing in the correspondence, and neither would expose what dowry of the $27 billion they will pay. A statement from Cigna said, "In edict to facilitate the village, we in agreement to micturate a contribution, as extended litigation is not in anyone's charles Herbert Best interest. We believe that at all times, Cigna fulfilled its obligations to the province of New York." Business practices employed by Express Scripts "already comply with essentially all requirements of the colonization" and only "minor adjustments in sure procedures testament be needful due to the settlement," according to the Cigna statement. Express Scripts said that it did non conduct brand drug "remedial interchange programs" for the Empire Plan and that it does not commend switching from higher-cost to lower-cost drugs or accept drugmaker funding for such programs (Hartford Courant, 7/30).
Reprinted with kind permission from hTTP://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or mansion up for email manner of speaking at hTTP://www.kaisernetwork.
