Express Scripts targeted by Arkansas pharmacies in first-of-its-kind lawsuit
Reporter: Rebecca Pifer Parduhn
Dive Brief:
A group of independent pharmacies in Arkansas are suing Express Scripts, one of the largest pharmaceutical middlemen in the U.S., for allegedly underpaying for tens of thousands of prescriptions.
The lawsuit filed Tuesday, which seeks hundreds of millions of dollars in damages, is the first filed under a state law passed last year giving Arkansas pharmacies the ability to go after PBMs for reimbursing them below the acquisition cost of drugs, according to lawyers for the plaintiffs.
"We're committed to reimbursing pharmacies at competitive rates and will defend ourselves against these allegations," an Express Scripts spokesperson said.
Dive Insight:
Under Arkansas law, PBMs aren't allowed to reimburse pharmacies less than their cost of acquiring a drug, measured by a metric called the National Average Drug Acquisition Cost, or NADAC.
NADAC is maintained by the federal government, and easily accessible by PBMs like Express Scripts — as are details like drug cost, quantity and fill date, everything the middlemen need to apply proper pricing when a drug is dispensed, according to the complaint filed Tuesday in Missouri circuit court.
But Express Scripts still reimburses pharmacies well below the NADAC, the lawsuit alleges, forcing them to absorb the revenue shortfalls or invest valuable time and resources to appeal improper payments.
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