Anthem, Express Scripts Face Legal Challenge Over Prescription Drug Prices

[Sherman A1]

http://khn.org/news/anthem-express-scripts-face-legal-challenge-over-prescription-drug-prices/

Anthem and its pharmacy manager Express Scripts overcharged patients with job-based insurance for prescription drugs, alleges a lawsuit that seeks class action status for what could be tens of thousands of Americans.

It’s the latest wrinkle in a battle that has already pitted the major national insurer and its pharmacy benefit manager (PBM) against each other in dueling legal actions — and further illustrates the complicated set of factors that determine what consumers pay for prescription medications.

The case alleges that insured workers paid too much because Express Scripts charged “above competitive pricing levels” and Anthem, in effect, allowed those higher prices as part of a 10-year contract deal with the pharmacy management firm. Those actions, it alleges, violate the firms’ responsibilities under a 1974 federal benefits law called the Employee Retirement Income Security Act.

“This action seeks to recover losses suffered by the plaintiffs … who overpaid and continue to overpay for the portions of the costs of prescription drugs … they are responsible for paying as plan participants,” says the lawsuit, filed as Burnett v. Express Scripts and Anthem.

[JustAnotherGen]

1. Hence why I ignore Express Scripts calls

They are overly aggressive in their marketing ploys.

I use one prescription -Restaysis to support my eye plugs (side symptom of A.S.). Just got another six month supply. Two months ago they started hounding me. Rite Aide charged me $86 with insurance - theirs was quoted as $103.

It pays to ask and keep your local pharmacist.

[Ruby the Liberal]

2. I hope they sue each other into oblivion

Express Scripts has taken over PhRMA management for my employer-based BCBS plan as of this past January. I hate them with the heat of 1,000 suns. Never in my life have I seen such incompetence on parade as with these ass clowns.

[1939]

3. My experience is different

Express Scripts handles the pharmacy benefits for Tricare for Life and for the last twelve years has given me great service. They are very accessible and friendly in my telephone dealings with them and my co-pays are just a token. For short term scripts, I go to CVS and they deal with Express Scripts seamlessly. If a doctor does keep subscribing the same thing, I get a letter from Express Scripts warning me to get a 90 long term "maintenance scrip" from my doctor so that they can fill it by mail order. The mail order responses are very rapid and reliable.

[Ruby the Liberal]

6. That sounds ideal

I'm glad its working for you, and gives me hope that I've just had a few bad experiences. 3 issues in 6 months doesn't leave much 'benefit of the doubt' right now.

[csziggy]

4. Yes! That would be so perfect - they are both horrible companies

Anthem was the worst of the half dozen or so employer supplied health insurance companies my husband had while working. They routinely denied every claim at least once. They required more paperwork, time and patience than any other company that covered us. I was so glad when his employer changed from Anthem.

Express Script earned a special place in hell as far as I was concerned. We were heavily pressured to use them by the insurance company and promised that we would save a lot of money by letting them send us three months supply at a time. I'd had a hysterectomy and needed hormone patches. I already knew that the generic was not equivalent to the brand name and caused massive migraines - one of the several reasons I had gotten the hysterectomy.

My doctor wrote the prescription to restrict it to just the brand name and specifically barred filling it with the generic. Sure enough, Express Script filled it with three months of the generic. Since the need had been "filled" the insurance company would not authorize another prescription for the brand name that the doctor gave me so I paid for the brand name out of pocket for those three months. Express Script would not take back or refund the unusable generic. I complained to the Texas Board of Pharmacy and after three years, long after we were no longer covered by that particular insurance company, I got a refund for the incorrectly filled prescription.

Several of the companies we were covered by over the years tried to pressure us into using Express Script. I kept demanding to be taken off their calling and mailing list, but Express Script told me by their contract with the insurance companies, they HAD to contact us. I got to the point as soon as they identified themselves I would tell them to stop calling, and where they could go and then I would hang up - violently. I only opened their mail to see if they had refunded my money. The eventual check did not come from them but from the agency that forced the refund.

I wouldn't trust any drugs they dispense since they obviously don't read or follow the prescription as written by the doctor!

[Ruby the Liberal]

5. I wish I could say I'm surprised

A colleague went through a similar thing with them that you did, after we switched this year - but in his case, it was insulin. His Doc had to give him an emergency supply until they figured it out. Fortunately, my problems haven't been life threatening, but the sheer number of calls you have to make if, god forbid, they get something wrong in their system (and have no idea how to correct it) is mind numbing.