Anthem sues Express Scripts for $15 billion over drug pricing

Health insurer Anthem has sued Express Scripts Holding Co., alleging the pharmacy benefits manager is not passing along billions of dollars in savings from negotiated drug prices.

Anthem is seeking $15 billion in damages and the ability to end its contract with Express Scripts. An Anthem spokeswoman said the damages reflect drug price overpayments Anthem allegedly has made. It also factors in the remainder of Anthem’s 10-year contract with Express Scripts, which runs through 2019. The amount also covers an unspecified transition period.

Anthem is also seeking $150 million for “compensation related to operational breaches,” the spokeswoman said. Anthem has not yet decided whether it will immediately end its contract with Express Scripts, but the company has been contemplating a major change for the past several months.

Anthem CEO Joseph Swedish told investors at this year’s recent J.P. Morgan Healthcare conference that Anthem was overpaying for prescription drugs for its members by $3 billion annually through its Express Scripts contract and was “contractually entitled” to those savings.

By Bob Herman in Modern Healthcare, March 21, 2016