Express Scripts will pay Missouri $246,053

Friday, May 30, 2008 | 4:45 p.m. CDT; updated 3:34 p.m. CDT, Tuesday, July 22, 2008

JEFFERSON CITY — Express Scripts Inc. will pay Missouri $246,053 as part of a settlement amid allegations concerning the company’s drug switching program, Missouri Attorney General Jay Nixon’s office said.

Express Scripts is a pharmacy benefits management company based in St. Louis and serves clients in both the United States and Canada, according to its Web site.

Express Scripts pays claims and provides mail-order pharmacy services for MU employees, Associate Vice President of Benefits Mike Paden said. Upon learning of this settlement, Paden said he would begin finding out which drugs were involved so he can assess the impact it might have had on MU employees.

The $9.3 million agreement announced Tuesday involves Missouri and 28 other states and the District of Columbia, the attorney general’s office said in a news release Tuesday.

“Essentially, we believe that Express Scripts was trying to get the doctors to switch the patients to brand-name drugs so that there would be more money that would be paid for the drugs,” said Scott Holste, a spokesman for the attorney general.

Holste said that the switch was made but that the doctors were led to believe that patients and health plans would save money. However, there wasn’t sufficient information given to the patients showing financial benefit for them, he said.

Express Scripts doesn’t think it did anything wrong. Company spokesman Steve Littlejohn said the definition of drug switching was narrowly defined and pertains only to a few prescriptions before 2004, when an investigation began into pharmacy benefit management companies, including Express Scripts. He said that Express Scripts doesn’t participate in the type of drug exchanges that were defined in the allegations and that drug exchanges are done only at the direction of a client.

“Our job is to help make pharmacy benefits safer and more affordable,” he said.

Representatives of Express Scripts and the attorneys general negotiated an assurance of voluntary compliance and discontinuance, Littlejohn said. Nixon filed an assurance of voluntary compliance in Cole County Circuit Court on Tuesday, which “resolves the concerns” the attorneys general had with Express Scripts, the Nixon news release said.

The attorneys general obtained a great deal of information from Express Scripts about its practices, Vermont Assistant Attorney General, Julie Brill said. Vermont’s Attorney General’s office signed the assurance of voluntary compliance with Express Scripts. Brill said the results of the investigation were discussed with the company, leading to the settlement.

As a part of the agreement, Express Scripts must give particular financial and medical information to patients regarding drug exchanges, Holste said. If there is any financial incentive for Express Scripts to switch drugs, or if co-payment levels differ, doctors and patients should know about it, he said.

Littlejohn said changes will be very minor, such as switching the method of disclosure to a scheduled notification, rather than notification throughout the year.

“Essentially in this agreement we agreed to continue doing what we already do,” he said.

Although Express Scripts admits no wrongdoing, Littlejohn said the company settled to save time, money and the attention the investigation would require.

“We cooperated fully in this investigation,” he said.

All states involved will receive a portion of the settlement’s amount. Holste said that when multi-state groups work together and take actions against companies such as Express Scripts, the settlement payment to each state is determined by how much impact each state experienced and the resources it invested in the investigation.

Brill said each state must use a portion of its payment to benefit low-income, disabled and elderly consumers. Vermont will use $100,000 of the $372,500 it received in the settlement on programs to benefit those groups. The use of Missouri’s payment has yet to be determined, Holste said.

The settlement allocates an additional $200,000 to reimburse affected consumers “for out-of-pocket expenses,” a news release by Express Scripts says. The agreement says that the payment for each patient will be no more than $25 and that claims must be submitted to Express Scripts within six months of when the patient receives a claim form from the company.

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