Officials from pharmacy benefit manager Express Scripts on Tuesday said the company has agreed to pay $9.5 million to settle lawsuits brought by 28 states and Washington, D.C., alleging it defrauded the states and D.C., the AP/Denver Post reports.
The agreement ends a four-year investigation into whether the company persuaded doctors to change patients' cholesterol drug prescriptions to brands for which Express Scripts would receive a rebate under the false premise that the savings would be passed along to patients.
Under the agreement, Express Scripts will pay $9.3 million to the states and an additional $200,000 to patients in payments of no more than $25 each as reimbursement for doctors visits and tests linked to switching cholesterol drugs. The PBM also must make "clear and conspicuous disclosures" about its drug-switching procedures (Jewell, AP/Denver Post, 5/28). Express Scripts also will be prohibited from asking that physicians switch patients to higher-priced drugs, asking for a switch when a generic equivalent is available or if the patent on the original drug is to expire within six months, and asking for a change after a patient has been switched to a new drug in the past two years (Raleigh News & Observer, 5/27). Express Scripts said it would need to make "only minor adjustments" to meet terms of the deal (AP/Denver Post, 5/28).
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