Express Scripts and Humana face price-fixing lawsuit in Ohio

Government pressure on pharmacy managers continues to escalate, this time Ohio Attorney General Dave Yost (R) alleges that three large companies and a foreign group buying organization have colluded to fix prescription drug prices and reap the rewards.

Express Scripts, a subsidiary of Cigna, and Prime Therapeutics, a subsidiary of Blue Cross and Blue Shield, have been working with Swiss company Ascent Health Services to increase the price of medicines, including insulin, according to the lawsuit filed by the Attorney General on Monday.

Through Ascent Health Services, Express Scripts, Prime Therapeutics and Humana Pharmacy Solutions share drug pricing and discount information and set discounts and prices between each other, Ohio said. Express Scripts founded Ascent Health Services in 2019, Prime Therapeutics is a minority owner and Humana Pharmacy Solutions is a client.

Ascent Health Services, Cigna and its Express Scripts, as well as subsidiaries of Evernorth Health, Prime Therapeutics, Humana and Humana Pharmacy Solutions are named as defendants. Prime Therapeutics declined to comment on the ongoing lawsuit. Other companies did not immediately respond to requests for comment.

Express Scripts is one of the top three PBMs along with CVS Health’s Caremark and UnitedHealth Group’s OptumRx, which together control over 75% of the market. Yost alleges in the lawsuit that Express Scripts is using its bargaining power to create a “pay to play” discount system that encourages drug makers to raise prices for better formulary placement.

“The cost of Express Scripts’ ultra-competitive profits has been passed on to those with the least power, including those whose prescription costs are calculated at or as a percentage of the same rising list prices,” the lawsuit says. The document, filed in the Delaware County Court of Common Pleas, calls on defendants to stop “covert and anti-competitive behavior” that drives up drug prices.

According to the lawsuit, these actions caused the price of insulin to skyrocket from about $20 per unit in the late 1990s to $300–700 per unit in 2023. President Joe Biden passed legislation last year capping the cost of insulin at $35 a month for Medicare recipients, and major manufacturers Eli Lilly, Sanofi and Novo Nordisk subsequently passed voluntary price caps on diabetes drugs.

Federal and state regulators are increasingly scrutinizing these so-called drug market middlemen, including a slew of lawsuits from states alleging that PBMs are stealing from Medicaid.

House Oversight and Accountability Committee Chairman James Comer (R-Kentucky) launched an investigation into PBM’s alleged anti-competitive practices this month. Comer requests information from CVS Caremark, OptumRx and Express Script. The Senate bill would ban pharmacy PBM “returns” and require companies to disclose spread and pharmacy fee pricing schemes. The Federal Trade Commission is also investigating the impact of the PBM industry on pharmaceutical prices.

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