Novartis kickback case settlement will cost Express Scripts $60 million
- According to Justice Department allegations, Novartis offered refunds to a specialty pharmacy run by pharmacy benefits giant Express Scripts in exchange for steering patients to refill Exjade, a Novartis treatment for excess iron. Scripts will pay $60 million to settle the allegations.
- The arrangement allegedly lasted from 2008 to 2012, resulting in four years of Medicare, Medicaid, and other programs being defrauded, according to federal officials.
- As a rule, Novartis does not disclose information about financial incentives to specialty pharmas to health plans, physicians, or patients.
This latest set of allegations from the Department of Justice started with a whistleblower lawsuit in 2011 from a Novartis sales manager. The general content of the suit claimed that Novartis used rebates and other mechanisms to boost sales of certain drugs at specialty pharmacies.
This is a direct violation of federal law, and this is not the first time that Novartis has faced such accusations. Two years ago, another former Novartis employee put forth allegations about kickbacks that Novartis was offering doctors, in the form of speakers' fees and lavish trips, in order to boost prescribing.
The biggest threat for Novartis would be if a court decided that the company had violated its Corporate Integrity Agreement (CIA), which was initiated in 2010; however, the outcome—beyond the $60 million fine—is not clear at the moment.