- On January 12th, the CEO of health insurance provider Anthem, Joseph Swedish, accused Express Scripts of overcharging Anthem by $3 billion a year on drug prices.
- Since Swedish' comments at the JPMorgan Healthcare Conference, Express Scripts' stock sunk by nearly 20%.
- Express Scripts now faces further trouble as six compounding pharmacies named the PBM as the sole defendant in an antitrust lawsuit. Express Scripts is accused of colluding with other PBMs to squeeze compounding pharmacies out of the market.
It's been a rough start to 2016 for Express Scripts. During an investor presentation at the JPMorgan Healthcare conference, Swedish claimed Anthem was entitled to $3 billion in improved drug pricing from the PBM. Express Scripts, however, denied the agreement between the two firms mandated any precise savings. Swedish went as far as threatening a break-up from Express Scripts. Unsurprisingly, Express Scripts stocks took a major hit.
In the lawsuit filed January 15 against Express Scripts, Precision Rx Compounding and five other compounders allege "an ongoing and multi-faceted conspiracy between the nation's largest pharmacy benefit managers...to jointly boycott compounding pharmacies to eliminate Plaintiffs from the market for pharmaceuticals covered by group and individual health plans."
While Express Scripts was the only defendant named, the lawsuit also accuses CVS Health, Optum Rx, and Prime Therapeutics of being co-conspirators with Express Scripts. The plaintiffs argue the PBMs have improperly decided reimbursement rates for prescribed drugs by acting as "gatekeepers," and then subsequently conspiring to eliminate coverage for compounded ingredients.
The lawsuit was filed in the U.S. District Court for the Eastern District of Missouri.