Caremark

Walgreens agrees to $35M drug-switching settlement

Thu, 05 Jun 2008 06:59:58 -0400

Walgreen Co. has agreed to pay $35 million to the U.S. Department of Justice to resolve allegations that it had switched patients to more expensive drugs to boost its Medicaid reimbursement. In the settlement, Walgreen Co. denies any wrongdoing. The case arose from a whistle-blower suit filed in 2003; the whistleblower asserted that between 2001 and 2005, Walgreens dispensed capsules rather than tablets of generic Zantac and Prozac, and brand-name and generic Eldepryl to Medicaid patients when doctors hadn't specified. Forty-six states and Puerto Rico will share the $16.4 million, and the federal portion of the settlement is $18.6 million. Whistleblower Bernard Listiza should receive a total of $5 million, which will be drawn from those moneys.

To learn more about the case:
- read this Modern Healthcare article (reg. req.)

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Express Scripts pays $9.5M settlement over drug switching

Wed, 28 May 2008 06:59:58 -0400

Pharmacy benefit manager Express Scripts has agreed to pay a total of $9.5 million to 28 states and the District of Columbia to settle allegations that it engaged in deceptive prescription-switching practices. The attorneys general involved had been investigating the company, arguing that Express Scripts switched patients to brand-name cholesterol drugs in an attempt to maximize the volume rebates it got from drug manufacturers. While patients were told they'd benefit from the switch, they actually ended up incurring some expenses from the change, according to the Pennsylvania AG's office. In signing the agreement, the company didn't admit any wrongdoing.

Under the terms of the settlement, Express Scripts agrees that it no longer will solicit patient drug switches if the cost exceeds that of the original script, if the original drug has a generic equivalent while the switch doesn't, if the original drug's patent will expire in six months, or if the patient was switched within the last two years. Express scripts also agreed to disclose any financial incentives it may have for soliciting a prescription switch and to reimburse patients for any related costs they might incur.

To learn more about the settlement:
- read this Modern Healthcare piece (reg. req.)

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More pluses than minuses in eventful week for retail clinics

Fri, 14 Mar 2008 07:59:59 -0400

So, it looks like retail clinic news has been a matter of two steps forward, one step back. For example, Cigna has just announced that it would pay for care delivered at another retail clinic chain, increasing its reach to quite a large number of such clinics. This bodes well for other larger commercial insurers to take similar steps, which can only help accelerate the growth of the industry.

On the negative side of the column, meanwhile, retail clinic chain Medical Marts has shuttered operations. And more worrisome, for people pushing the retail clinic model, the state of Illinois is pondering rules that would slip in a provision preventing stores that host clinics from selling tobacco or alcohol, a requirement most retailers just couldn't afford. My gut feeling is that this won't pass, though you never know how regional politics will play out. It seems transparently on the punitive side, which will turn off all but the most ardent clinic opponents.

Still, there's no sign that the industry as a whole is slowing down. For example, Walgreens has already rolled out almost 150 Take Care brand clinics, and plans to have 400 in its stores by the end of 2008. CVS/Caremark, for its part, opened its 500th clinic last week. And let's, by no means, forget about Wal-Mart, which is steamrolling ahead toward its larger goal of implementing about 2,000 clinics over the next several years--at this point, focusing largely on partnerships with providers.

Sure, if they can get away with it, state medical societies are going to continue to push measures that will limit or even prevent the emergence of retail clinics. But I don't think they will. From where I sit, the retail clinic industry may be evolving into a model where existing providers, rather than smaller entrepreneurial companies, are likely to drive the train, but I'm pretty confident the train will keep rolling. - Anne