Upcoming Webinars Archived Webinars Training Vitals Host A Webinar About Get Updates Contact

Anthem Files Lawsuit Against Express Scripts Over Drug Pricing Dispute


Drug Pricing

Anthem claims that they are overpaying for pharmaceuticals, despite the availability of rebates that Express Scripts negotiated with pharmaceutical companies.

Share this!

March 23, 2016 | by Sarah Massey, M.Sc.

On Monday, health insurance company Anthem Inc. filed a lawsuit against their pharmacy benefit manager, Express Scripts, to reportedly recover damages due to pharmaceutical pricing and operations issues. Anthem claims that they are overpaying for pharmaceuticals, despite the availability of rebates that Express Scripts negotiated with pharmaceutical companies.

As such, Anthem may be looking for a way out of its contract with the pharmacy benefit manager. Express Scripts is currently responsible for overseeing drug benefits for 80 million people.

“Under the agreement, Express Scripts is obligated to negotiate in good faith to ensure Anthem is receiving competitive benchmark pricing,” said Anthem. “Anthem has worked hard for more than a year to try to get Express Scripts to engage in such good faith negotiations, but Express Scripts has refused to do so.”

In January, Anthem’s CEO Joseph Swedish said the company was entitled to over $3 billion in rebates, based on their estimates of how much they are currently overpaying for prescription drugs. Though Express Scripts is the US’s largest pharmacy benefit manager, Anthem could be willing to drop them before their contract runs out in 2019.

“Express Scripts values its relationship with Anthem and will continue to honor its commitments under the contract, as we would do with any client,” said Jennifer Luddy, a spokesperson for Express Scripts. “Express Scripts has consistently acted in good faith and in accordance with the terms of its agreement with Anthem. We believe that Anthem’s lawsuit is without merit.”

Chief Medical Officer of Express Scripts Steve Miller, has been very outspoken about the discounts his organization is able to negotiate with drugmakers. The pharmacy benefit manager has even gone so far as to refuse to cover some brand-name medications, instead offering patients alternatives made by companies that have given Express Scripts a better deal.

According to a report released by the pharmacy benefit manager, the cost of brand-name prescription pharmaceuticals has jumped by 164 percent since 2008. In the same period, the price of generics has plummeted by 70 percent.

Anthem’s former pharmacy benefit manager was sold to Express Scripts in 2009, with the condition that insurer would use the company’s services for a 10 year period. Under the terms of the contract, the companies should have renegotiated drug prices in December of 2015.

Keywords: Drug Pricing, Health Insurance, Pharmacy Benefit Manager


Share this with your colleagues!

Antibiotics Could Be Viable Treatment For Mild Appendicitis

March 22, 2016 - According to researchers at the University of Helsinki, patients with mild appendicitis who were treated with antibiotics do not have a higher risk of developing complications, within one year of starting treatment.

Stem Cells With Half The Normal Number Of Chromosomes To Revolutionize Medical Research

March 21, 2016 - The scientists have successfully generated human embryonic stem cells with just one copy of the 23 human chromosomes.

Cellectis Partners With MabQuest To Develop New Cancer Immunotherapy Antibodies

March 21, 2016 - French biopharmaceutical company Cellectis and Netherlands-based biotech MabQuest, have announced they will be collaborating to develop a novel class of monoclonal antibodies that are antagonistic to a protein called PD-1.


Five Reasons Why Toronto is Emerging as a Major Life Sciences Hub


Development and Manufacture of Highly Potent API Drug Products Throughout the Clinical Phases

Innovation through Integration – Providing Next Generation Biomedical Devices and Interconnects

Clinical Payments Case Studies: Improving Efficiency, Cash Management, and Compliance

Why Phase 3 Trials Fail: Oncology Case Studies and Lessons Learned

Copyright © 2016-2017 Honeycomb Worldwide Inc.