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PBMs: Spitzer puts the boot into Express Scripts

NY A-G Eliot Spitzer continues his swath through the boardrooms of America. He’s piling in on the recent investigations and he comes right out and accuses Express Scripts of fraud.

The suit alleges the company inflated the cost of generic drugs at the expense of New York state’s largest employee health plan, the Empire Plan. It charges the company cheated the state on payments from drug companies that Express Scripts received when negotiating on behalf of New York. Spitzer, who has been probing the company for a year, said the abuses occurred over a five-year period and cost the state $100 million. Also named as defendants were two subsidiaries of Cigna Corp.

“They are using their role as an intermediary to line their own pockets,” he told reporters on a conference call. “They were simply committing fraud, and it cuts to the core of the integrity of the company.” Spitzer said abusive practices are not limited to Express Scripts but are rampant throughout the sector. Pharmacy benefits managers, or PBMs, are brokers that act as middlemen, buying drugs for employers and health plans.

That’s not exactly soft speaking, and it doesn’t augur well for PBMs if they have to administer a Medicare program in 2006 that is being run by a Democratic HHS, with possibly a Justice department overseen by an Attorney-General called Spitzer.

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> > Dear Mr. or Ms. D.(undisclosed for privacy) > > Thank you for contacting Express Scripts. > > We have researched your account and have found that you have called in > and spoken with a patient care advocate and you were advised that your > order form was “checked” for no generics. Our records indicate that a copy > of the order form is being sent to you. We are unable to accept a return > on the medication. We apologize for any inconvenience. If you have any > further questions, please contact customer service by phone at… Read more »