A new class-action lawsuit filed in Pennsylvania is accusing Express Scripts of overcharging for patient records, an alleged violation of state and federal laws.
The lawsuit, filed in the U.S. District Court in the Western District of Pennsylvania, says the pharmacy benefit manager charges a flat fee of $75-$90 for any request for pharmacy records, regardless of the volume.
The company attributes the fee to “data processing,” according to the complaint. The Pennsylvania man that brought the case said he paid the $90 fee for six pages of records.
“Defendant charges and collects excessive and inflated amounts which are in no way related to the actual costs incurred, and thus constitutes unfair, unreasonable, and/or unconscionable price or fee under the common law,” the complaint (PDF) says.
The lawsuit says Express Scripts raised its nonrefundable fee to $90 in April without “any explanation for how or why the cost was increased or whether it was reasonable.”
It’s the third such lawsuit that has been filed against Express Scripts over the last several years. Two separate class-action complaints, filed in Florida and Kentucky, have made similar claims. The Pennsylvania plaintiff alleges there are “more than 1,000” third-party requests from patient representatives in Pennsylvania that paid fees to Express Scripts.
"Express Scripts intends to vigorously defend these allegations," an Express Scripts spokesperson said in an emailed statement.
Under HIPAA, covered entities may charges “reasonable, cost-based fees for the cost of copying and postage.” The law allows covered entities to charge a flat fee of $6.50 to obtain their medical records or more by calculating the allowable fees to fulfill the request.
That regulation has been challenged in court by medical records request company Ciox.