Has your pharmacy benefits provider overcharged you for the medication you need?You purchase health insurance to provide you with fair access to health care and prescription drugs. Unfortunately, for many Americans the prescription benefits managers used by their health insurers are overcharging them for their prescription medications.

This is an unfair, unethical, and unacceptable practice that must change. 

Anthem's Agreement With Express Scripts

Health insurance companies, such as Anthem BlueCross BlueShield, contract with pharmacy benefits managers, such as Express Scripts, to provide prescription benefits for health plan subscribers. Anthem and Express Scripts are currently in the middle of a ten-year agreement that has Express Scripts providing pharmacy benefit management services to more than 15 million people in 24 states. In 2009, Express Scripts paid Anthem more than $4.5 billion to be Anthem’s sole provider of pharmacy benefit management services.

However, health plan participants and Anthem allege that Express Scripts is charging too much for the prescription drugs it provides.

Individuals have reportedly experienced problems such as…

  • Express Scripts personnel denying receipt of prescription information from a physician.
  • Being required to pay out-of-pocket for medication while waiting for Express Scripts to approve a prescription.
  • Finding the same prescriptions available for significantly less money outside the Express Scripts insurance system.
  • Poor or no communication with Express Scripts about their complaints.

Some individuals—and Anthem—have taken legal action, according to Bloomberg BNA.

Anthem Sues Express Scripts

In March 2016, Anthem sued Express Scripts for allegedly violating the terms of their contract. More specifically, Anthem alleged that Express Scripts overcharged Anthem health plan subscribers in violation of the 2009 contract between the two parties. The lawsuit claimed more than $15 billion in damages and Anthem reportedly wants to end its contract with Express Scripts as soon as possible. Express Scripts denies Anthem’s claims and says that the lawsuit has no merit.

Anthem Subscribers Also Sue Express Scripts

After Anthem filed its lawsuit against Express Scripts, health plan subscribers also filed legal cases.

In May 2016, two individuals sued both Anthem and Express Scripts alleging that Express Scripts overcharged them for prescriptions in violation of the Employee Retirement Income Security Act (ERISA).

In June 2016, Anthem subscribers from employer-based medical insurance plans sponsored by Verizon Communications, AmTrust Financial Services, and LG&E and KU Energy also filed a lawsuit against Anthem and Express Scripts. The group is seeking class-action status and may represent more than 26,000 health plan subscribers. These subscribers claim that they have overpaid and continue to overpay for the costs of their prescription medications and that this is a violation of their health insurance agreements. Specifically, they claim that:

  • Anthem and Express Scripts breached their fiduciary duties pursuant to ERISA by agreeing to a ten-year prescription drug agreement that resulted in health care subscribers overpaying for medication benefits.
  • Anthem did not appropriately monitor Express Scripts or prevent the company from overcharging plan participants.
  • Anthem used the 2009 multibillion-dollar contract payment from Express Scripts to benefit stockholders and company managers and did not pass on this financial benefit to health plan participants.

An independent market analysis found that Express Scripts pricing was approximately $3 billion more than competitive benchmark pricing annually, and that overcharges to Anthem health insurance participants could be as much as $15 billion.

Both Anthem and Express Scripts have denied the claims—even as Anthem has filed its own case with similar allegations against Express Scripts.

Do You Have a Case Against Express Scripts?

If you have an Anthem health insurance plan through your employer or your spouse’s employer, and if you have obtained prescription medication through that plan, then you may have overpaid for your medications and you may have a legal claim. Similarly, if Express Scripts unnecessarily and unfairly denied your claim or took an unreasonable amount of time to fill your claim and you were hurt physically or financially, then you may have a legal claim.

It is important to know about your rights so that you can make an informed decision about your future. Health insurance can be complicated and it can be frustrating—but getting legal information doesn’t have to be like that. Instead, call our experienced legal team anytime—24/7—and get the honest answers that you deserve. Call us today at 888-450-4456 to learn more.

Matthew L. White
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Founder & Partner of Louisville Personal Injury Law Firm Gray & White Law
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