Monday, November 26, 2018

State Settles $500k Dispute with a Big Three Pharmacy Benefits Manager

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The Attorney General’s Office and the Vermont Department of Human Resources have settled a dispute with the State’s pharmacy benefits manager for $503,500. The State’s pharmacy benefits manager, Express Scripts, oversees management of prescription benefits for the State’s employees and retirees.

Tyrone's Commentary:

I want more than anyone that PBMs deliver radical transparency to their clients. I don't, however, believe organizations should be able to clawback overpayments from non-fiduciary PBMs for a bad deal it willingly signed. So, it makes me wonder why did Express Scripts settle when for decades it has thumbed its nose at complaints about overpayments? Winning radical transparency from non-fiduciary PBMs boils down to two things; knowledge and grit. Occasionally, the threat of a lawsuit or moving business to a competitor doesn't hurt.

The State will receive the settlement amount in increased guaranteed prescription rebates payable in 2019 for prescriptions purchased in 2018. The settlement resolves a dispute about charges paid by the State several years ago under a now-expired contract.

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