Ohio AG sues Express Scripts to reclaim drug overcharges

Ohio Attorney General Dave Yost has filed suit against Express Scripts, alleging that the pharmacy benefit manager was able to "pocket millions" by overcharging the state's Highway Patrol Retirement System, a public pension fund.

The suit seeks an unspecified amount in damages. Express Scripts has served as the PBM for the HPRS health plans since 2010.

The suit claims that in each year of the PBM contract, aside from 2011-2012, Express Scripts failed to meet pricing guarantees as laid out in the applicable pricing schedule, which led to overcharges on thousands of claims.

Express Scripts also regularly misclassified generic medications as branded drugs, which carry a higher price tag, the lawsuit alleges.

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“This particular PBM egregiously charged for services it didn’t deliver,” Yost said in a statement. “Its repeated breaches cost Ohioans millions, and we want our money back.”

Express Scripts said in a statement to Fierce Healthcare that it denies the allegations in the lawsuit and intends to "vigorously defend itself as the matter proceeds."

Yost has openly declared war on PBMs and has made investigating their business practices a critical initiative within his office. In March 2019, the AG also filed suit against Optum, seeking to reclaim $16 million in what he says are drug overcharges.

“It’s no secret that PBMs have been keeping secret their prescription pricing in order to evade public scrutiny and rake in revenue,” Yost said. “I intend to shed light on their business model and bring true transparency to the processthey need to answer the tough questions and repay what is owed.”