Ohio Attorney General David Yost has filed suit against Express Scripts and Prime Therapeutics, alleging the companies conspired to illegally increase drug prices.
In the lawsuit, Yost said that Express Scripts, one of the country's three largest pharmacy benefit managers, responded to criticism of its model by forming the group purchasing organization Ascent Health Services in 2019. It then granted Prime Therapeutics ownership in Ascent before moving its operations to Switzerland, which allowed it to further obfuscate its pricing models.
Yost alleged that Express Scripts and Prime then used their shared stake in Ascent to share pricing, discount and rebate information with one another as well as with Humana Pharmacy Solutions, an Ascent customer. This drove up prices further, according to the suit.
The lawsuit also names the PBMs' parent companies Cigna, Express Scripts and Humana.
“PBMs are modern gangsters,” Yost said. “They were designed to protect and negotiate on behalf of employers and consumers after Big Pharma was criticized for overpricing medications, but instead they have absolutely destroyed transparency, scheming in the shadows to control drug prices on all sides of the market.”
Cigna had not returned a request for comment at the time of publication. The company generally does not comment on pending litigation.
Yost's office said in a news release that the alleged scheme would have had negative impacts on patients, drugmakers, pharmacies and employers.
Ohio's attorney general has been a vocal critic of PBMs and the models they deploy to manage drug spend, particularly rebates and spread pricing. He has filed multiple lawsuits against different PBMs, making this week's filing just the latest salvo in a lengthy war.
In the news release, Yost points to insulin as an example of how PBMs can drive up drug costs. He said that "Express Scripts' well-concealed scheme" using rebates has led to an "astronomical" increase in the price of insulin over the past several decades.
He said that 1.1 million people in Ohio alone are diabetics. Insulin pricing has long been a concern in the broader conversation about rising drug costs.
“Medications shouldn’t cost an arm and a leg, metaphorically or literally,” Yost said. “Insulin is just a symptom of the problem; PBMs are the disease.”
PBMs have taken plenty of heat in the debate over who is at fault for rising drug costs, and pharmaceutical manufacturers typically blame PBMs for driving up expenses. Multiple congressional committees are digging into these companies, as is the Federal Trade Commission, which subpoenaed five of the largest PBMs last year.