Latest news with #ExpressScripts'
Yahoo
29-04-2025
- Business
- Yahoo
Nessel takes action against pharmacy benefit managers over anticompetitive practices
Getty Images Michigan Attorney General Dana Nessel on Monday filed a lawsuit against two pharmacy benefit managers accusing the companies of engaging in anticompetitive conduct that crippled the state's independent pharmacies and created pharmacy deserts within the state. The suit argues that two companies, Express Scripts Inc. and Prime Therapeutics LLC, made an unlawful agreement to suppress reimbursement rates to independent pharmacies. According to a statement from Nessel's office, this allowed the companies to make excessive profits and contributed to the closure of pharmacies in Michigan and across the state. Pharmacy benefit managers act as intermediaries between insurance providers, drug manufacturers and pharmacies, negotiating discounts and rebates with manufacturers and reimbursing pharmacies for the prescriptions they fill on behalf of the insurance company. In December 2019, Express Scripts and Prime Therapeutics allegedly entered into an agreement for Prime Therapeutics to adopt Express Scripts' lower reimbursement rates in exchange for accessing Express Scripts' buying power and pharmacy network while paying Express Scripts administrative fees. Pharmacies outside this network allegedly received less money for filling prescriptions to the degree that some pharmacies paid more to dispense medication than they were reimbursed. Nessel argues the two companies' agreement contributed to the creation of pharmacy deserts in half of Detroit's neighborhoods and numerous communities throughout northern Michigan. Her suit aims to terminate the agreement, among other remedies. 'Michigan residents should not have to drive 45 minutes, or sometimes even farther, to pick up the insulin, heart medication, or antibiotics they need,' Nessel said. 'Yet the unlawful, anticompetitive agreement that the lawsuit alleges has handed these PBMs unprecedented control over which pharmacies receive medication, how quickly residents get their prescriptions, and how much they're forced to pay — crippling small, independent pharmacies and restricting access to lifesaving medications in the process.' 'With this lawsuit, we are putting an end to these harmful practices to ensure Michiganders have reliable, affordable access to the medications they depend on,' Nessel said. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Associated Press
29-01-2025
- Business
- Associated Press
Evernorth Announces New Cost and Transparency Protections for its Express Scripts Patients
Actions aim to lower patient out-of-pocket costs Expands transparency for both patients and those who provide their benefits BLOOMFIELD, Conn., Jan. 29, 2025 /PRNewswire/ -- Evernorth Health Services, a subsidiary of The Cigna Group (NYSE: CI), today announced several steps it is taking to improve costs and transparency around pharmacy benefits. These changes aim to help patients benefit directly from Express Scripts' negotiations to lower the cost of prescription drugs. They will also enhance transparency about these negotiations for both patients and those who provide their benefits. 'We know that health care and prescription drugs need to be more affordable, and that coverage needs to be more transparent and less complex,' said Eric Palmer, President and CEO of Evernorth Health Services. 'While we advocate for the lowest costs for the more than 100 million Americans we serve, we know there are times where the system falls short. We hear the concerns of patients, plan sponsors and the public, and are making these commitments as one step to do more to help patients get their medications at the lowest cost and improve transparency to enable more informed choices.' Today, Evernorth is implementing protections to help lower costs for patients at the pharmacy counter. Helping All Patients Benefit Directly from Express Scripts' Drug Price Negotiations While today more than 80% of Express Scripts' patients pay less than $100 per year for their prescriptions, for some out-of-pocket costs still remain too high. This is especially true for patients in high deductible plans who may face the high list prices of medicines set by manufacturers. Evernorth is implementing protections to lower out-of-pocket costs for more patients. These actions are designed to help ensure patients receive the benefit of the savings Express Scripts generates through its negotiations. Going forward, Evernorth's standard offerings will provide the following protections: 1. Patients will be protected from paying the high list price of their medication, and will instead get access to the lower price negotiated by Express Scripts. 2. Patients in employer-sponsored plans will have improved financial predictability, receiving the benefit of the savings on medication costs that Express Scripts negotiates, if they don't already. This will be particularly meaningful to patients during their deductible phase when the cost of medications can be at their highest. Providing Patients and Plan Sponsors with New Pharmacy Benefits Summaries and Disclosures Express Scripts is also improving transparency through new reports which will: 3. Provide patients a personalized summary that details each patient's annual total prescription drug costs, including medication prices, negotiated savings inclusive of discounts and rebates, plan paid amounts, and total savings. 4. Provide plan sponsors with an annual standardized report disclosing costs and pharmacy claim-level reporting, which will create additional transparency beyond the routine reporting and insights Express Scripts already delivers. 'It is our goal to always exceed patient expectations for better health and to ensure there are no surprises at the pharmacy counter,' said Adam Kautzner, Pharm.D., President of Evernorth Care Management and Express Scripts. 'We want to do our part to lead change so patients can afford their medications and understand how their pharmacy benefits are working for them.' About Evernorth Health Services Evernorth Health Services creates pharmacy, care and benefits solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Evernorth capabilities are powered by our businesses, including Express Scripts, Express Scripts® Pharmacy, Accredo, EviCore and MDLIVE, along with holistic Evernorth platforms and solutions that move people and organizations forward. All Evernorth solutions are serviced and provided by or through operating affiliates of Evernorth Health, a wholly owned subsidiary of The Cigna Group (NYSE: CI), or third-party partners. Learn more at
