Ohio Attorney General Sues Express Script, Others for Inflating Drug Costs

Ohio Attorney General David Yost issued a statement to Ascent Health Services, Express Script, Cigna Group, Evernorth Health, Prime Therapeutics LLC, Humana Pharmacy Solutions, and Humana. filed a lawsuit for inflating prescription prices. Promote pharmaceutical sales by cooperating with overseas subsidiaries to share pricing information and obtain higher rebates from manufacturers.

Yost argues that market consolidation has enabled collusion among companies, with the three largest pharmacy benefit managers (PBMs) (including Express Scripts) controlling more than 75% of the pharmaceutical market, and the next three PBMs controlling the pharmaceutical market. Claimed to be in control of most. The rest he is 25%. Yost specifically invokes his Express Script many times in the complaint, saying that Express Script “created a black box that holds a complex management system that his PBMs, including Express Script, can enhance in a variety of ways.” said. At the expense of consumers and other industry players.

Yost called PBM a “modern gangster” in the lawsuit, saying that while PBM is designed to protect and negotiate on behalf of employers and consumers, it would rather “destroy transparency and reduce drug prices.” They are conspiring behind the scenes to control everything.” market. ” He went on to point out that with PBM dominating, sellers and buyers should play by their own rules.

Yost cited the 2019 formation of Ascent, a group purchasing organization (GPO) by Express Scripts, as “part of an evolving effort to add complexity and opacity to the marketplace.” Shortly after, Express Scripts invited competitor Prime Therapeutics to his Ascent. Ascent is purportedly used to share prices among members, so companies such as ExpressScript, Prime Therapeutics, and Ascent customer Humana Pharmacy Solutions all share drug prices and rebates. It is believed that they can share information with each other and modify the rebate price. between them.

The lawsuit further alleges that PBM uses its market power to harm competing pharmacies, especially smaller independent pharmacies. To maintain the insurance network, pharmacies are often forced to accept lower drug reimbursement rates than what pharmacies pay for their drugs. Minimal cost savings are actually passed on to plan sponsors or eligible individuals/patients. Instead, the customer pays a contract fee, which often exceeds what the pharmacy actually pays for the drug, and PBM allows him to pocket the profit between the two prices. The complaint also points out that pharmacies do not know how much PBM will reimburse for drugs until the patient receives them.

Yost cites Kroger’s ongoing difficulties with Express Scripting: A family owned pharmacy and locals in rural Ohio. ”

The complaint alleges that it violated Ohio’s antitrust laws, which prohibit price fixing, sales control and other agreements that restrain trade and impede competition. Yost said the arrangement between the defendants hurt not only patients but also pharmaceutical companies and pharmacies. Moreover, although the complaint specifically targets insulin, it also notes that similar situations occur with other drugs and biosimilars. “Insulin is just a symptom of the problem, and insulin is just a symptom of the problem,” Yost said in a press release announcing the lawsuit. PBM is a disease. ”

Yost is seeking statutory fines and deprivation of profits.

This follows lawsuits filed in January 2023 by California Attorney General Rob Bonta, alleging that multiple pharmaceutical companies and PBM used market power to overcharge patients for insulin.

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