Five pharmacies from four states have filed a class-action lawsuit against pharmacy benefit manager (PBM) Express Scripts for allegedly using confidential patient data to steer customers away from retail pharmacies and into mail order.
Courtesy: Shutterstock/Feng YuThe lawsuit was filed this month in United States District Court Eastern District of Missouri. The plaintiffs are Trone Health Services and Reddish Pharmacy (Idaho), Jabos Pharmacy (Tennessee), Oak Tree Pharmacy (Oregon), and Amrut JAL (Indiana). The pharmacies estimate that as many as 50,000 pharmacies could eventually join the action.
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The pharmacies allege that Express Scripts improperly used customer information and prescription data to steer customers away from their brick-and-mortar pharmacies into the PBM’s mail-order business. Express Scripts has access to the patient data to verify eligibility and to collect insurance payments. Express Scripts manages more than 25% of the insured in the United States.
David Whitrap, Express Scripts’ senior director of corporate communications, termed the lawsuit baseless and said the company would defend itself vigorously.
The pharmacies accuse Express Scripts of “slamming”—switching some customers into its mail-order business without the consumer’s permission. The company is accused of using prescription data to identify the most-profitable Rxs and then targeting those customers.
According to the complaint, after customers are switched to mail order, the pharmacies are notified that the prescription has been switched to mandatory mail order and that only Express Scripts will be authorized to fill refills.
The pharmacies also question the efficacy of mail order. They maintain that prescriptions sent through the mail are exposed to temperatures and humidity levels that exceed FDA regulations. The pharmacies claim that Express Scripts, not patients or insurance companies, is the only entity that benefits from mail order.
Since 2009, Express Scripts’ mail-order business has filled 41.8 million prescriptions. In 2013, Express Scripts reportedly collected $37.6 billion through its mail-conversion program—monies pharmacies complain would have been funneled through retail pharmacies.