Wednesday, July 30, 2008

Express Scripts...a more detailed coverage of the settlement

From John Curry, July 30, 2008
CIGNA, Express Scripts Settling Case With New York State
Courant Staff Writer
July 30, 2008
Express Scripts Inc. and CIGNA are paying a total of $27 million to settle a 2004 lawsuit by the state of New York that accused Express Scripts of getting doctors to switch patients' drugs and pocketing rebates from drug companies.
The allegations involved prescription benefits for New York's Empire Plan, which covered more than 1 million active and retired state and local government employees and dependents at the time. The suit also said Express Scripts inflated the cost of generic drugs for the plan.
CIGNA is involved in the settlement announced Tuesday because it insured the state's prescription drug plan and subcontracted Express Scripts to manage the drug plan benefits.
St. Louis-based Express Scripts was supposed to negotiate the lowest possible prices from drug makers for the New York plan and return any rebates to the state, New York said.
Eliot Spitzer, New York's attorney general at the time, said Express Scripts committed fraud by disguising rebates as administrative or other fees and keeping them. He had sought as much as $100 million in reimbursements, plus penalties and fines.
CIGNA and Express Scripts did not admit any allegations in the settlement, and neither company would disclose what share of the $27 million they are paying.
"In order to facilitate that settlement, we agreed to make a contribution, as prolonged litigation is not in anyone's best interest," CIGNA said in a written statement. "We believed that at all times, CIGNA fulfilled its obligations to the state of New York."
The 24-page settlement lays out a broad range of rules concerning drug-switching and disclosure of payments from drug makers to Express Scripts. But the company said Tuesday, "Express Scripts' business practices already comply with essentially all requirements of the settlement. Only minor adjustments in certain procedures will be needed due to the settlement."
Express Scripts said it did not conduct brand-drug "therapeutic interchange programs" (drug-switching) for the Empire Plan. The company also said it does not recommend switches to higher-cost drugs and does not accept drug makers' funding for such programs.
The settlement also applies to any pharmacy benefit plan that has its main place of business in New York and that is served by either Express Scripts or CIGNA.
Contact Diane Levick at

Labels: ,

Tuesday, July 29, 2008

STRS and.....this isn't the first time!

From Shirlee Zerkel, July 26, 2008
Subject: Wow, a letter from Exprees Scripts!

I received a letter from Express Scripts today. Wow! Six pages telling us over and over the same facts as if it is something new and wonderful. Well it isn't a new idea! I tried to deal with this same subject in September of 2004 when I spoke to the STRS Board about some retirees on Medicare B who were paying the co-pays of tier 3 for diabetic test strips and then never receiving any reimbursement for what Medicare paid the PBM (Advance, and then CareMark).

STRS staff could not wait to speak with me after my speech on the issue and wanted to know the names of the retirees. I told them to fix it for all the Medicare covered retirees and that would fix the problem. I tried to explain to STRS staff how this should work, but the only answer I got from STRS staff was that my idea was not possible. Now they are going to do it! At that time I had done much research with many retail pharmacies. Back at the end of 2004, pharmacies in my area of Ohio were coordinated with Medicare Part B, but the PBM we had did not have the same ability.

Paul Boyer and some of my other Medicare eligible friends in Lima stopped using the STRS BPM and were going to Rite Aid with only their Medicare Cards and they received free test strips. They did not even have to use their STRS prescription card. When I turned 65 in 2007. I went to Rite Aid, showed my Medicare card; Rite Aid had my Caremark card in their file and I was charged the STRS co-pay. I then asked to speak with the head pharmacist and I was told that the Caremark card is what caused the problem. Why? No answer! They again ran my prescription through their computer with only my Medicare Card and I walked out with NO co-pay.

I signed no COB in order to receive the test strips. This zero co-pay is not a new thing as the information from Express Scripts wants you to believe ( in answer for question 2 under General Information for Aetna and Medical Mutual Enrollees.)

Since I have been on Medicare, I have never had to tell the pharmacist that Medicare is primary and STRS is secondary as the letter tells you have to do. That is an understood fact by the providers, whether it is doctors, hospitals or retail drug stores.. Why could they not do in 2004 what they are doing now with a new PBM? Why did so many retirees have to pay so much for their test strips and never be compensated for them for so many years?

If Mr. Boyer were alive today, he would tell you all that he never received even one dollar in credit on his mail order account or a check for the amount he was overcharged order after order and year after year. Neither did other friends of mine, but I was told over and over again that all retirees were given credit for the Medicare reimbursements by the PBMs -- or that may be what the PBMs told STRS. I will gladly try to answer anyone's questions on this issue.

Shirlee Zerkel
Larry KehresMount Union Collge
Division III
web page counter
Vermont Teddy Bear Company