Anthem's public spat with Express Scripts has escalated into a lawsuit against the pharmacy benefits management company that charges it with failing to pass on prescription drug savings.
The lawsuit, which Anthem announced Monday, "seeks to recover damages related to operational issues and for a declaration of Anthem's right to terminate its contract with Express Scripts."
Anthem says it has tried to work with Express Scripts for more than a year to ensure that the insurer is receiving competitive benchmark pricing on prescription drugs, but says the company has refused to engage in good faith negotiations.
Express Scripts took issue with that claim.
"Express Scripts values its relationship with Anthem and will continue to honor its commitments under the contract, as we would do with any client," spokeswoman Jennifer Luddy said in an email statement. "Express Scripts has consistently acted in good faith and in accordance with the terms of its agreement with Anthem. We believe that Anthem's lawsuit is without merit."
Anthem says in the announcement that has not yet decided whether to end its contract with Express Scripts, which is set to expire in 2019, early. But Anthem CEO Joseph Swedish has already hinted that once the company acquires Cigna it may consider creating its own PBM company, saying in July that "there's significant value and opportunity for the combined company and our customers from a better pharmacy contract."
Such a move would follow UnitedHealth's decision to acquire Catamaran and fold it into its OptumRx subsidiary, a move that positioned it to compete with PBM giants CVS Health and Express Scripts.
The rift between Anthem and Express Scripts became public in January, when Swedish said during the JP Morgan Healthcare Conference that Express Scripts owed it $3 billion more per year in prescription drug savings due to a repricing provision in its contract. "To be clear, our shareholders are entitled to that value today, and our team has been and continues to be focused on exercising our contractual rights to capture that value," he said.
But Express Scripts CEO George Paz disputed Anthem's claim on an earnings call with analysts in February, saying "I have no clue where the $3 billion came from," FierceHealthPayer has reported.
To learn more:
- read Anthem's announcement
Express Scripts disputes Anthem's claim that it's owed $3B
Anthem, Cigna see pharmacy benefit management opportunities in merger
UnitedHealth to buy pharmacy benefit manager Catamaran for $12.8B
Drug exclusions help PBMs press pharma over high-cost meds