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Express Scripts to pay $3.2 mln to settle Massachusetts overcharge claims

  • Cigna unit accused of ignoring federal, state drug pricing benchmarks for workers' compensation beneficiaries

  • Massachusetts previously settled with UnitedHealth's OptumRx, pharmacies

(Reuters) Pharmacy benefit manager Express Scripts Inc has agreed to pay $3.2 million to settle claims that it overcharged Massachusetts' workers' compensation insurance system for prescription drugs, Massachusetts Attorney General Maura Healey announced Monday.


Under the agreement, Express Scripts, a subsidiary of Cigna Corp, also agreed to implement new protocols to ensure that it complies with the state's drug pricing regulations. It did not admit wrongdoing.


"Employers need a workers' compensation system that is functional, transparent, and affordable," Healey said in a statement. "Our office will take action to ensure pharmacy benefits managers follow procedures and do not drive-up costs in our workers' compensation system."


Under Massachusetts law, workers injured on the job are entitled to benefits including prescription drugs, whose prices are pegged to federal Medicare reimbursement rates and to a state-set benchmark.



The state alleged that Express Scripts failed to take into account those benchmarks in setting prices for prescriptions dispensed at some CVS Health Corp, Walgreens Boots Alliance Inc and Rite Aid Corp pharmacies. Pharmacy benefit managers like Express Scripts are intermediaries that negotiate prices with drugmakers and pharmacies on behalf of health plans.


Massachusetts reached a similar settlement in February with UnitedHealth Group Inc's pharmacy benefit manager OptumRx. It has also reached settlements with the three pharmacy operators totaling $10 million over related allegations.


The case is In the Matter of Express Scripts Inc, Suffolk Superior Court, No. 2284CV02520.

For Massachusetts: Assistant Attorney General Glenn Kaplan

For Express Scripts: Sarah Hellmann of Husch Blackwell

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