STAT+: Tennessee officials find Express Scripts violated law governing commercial pharmacy claims
In an unusual move, an audit of commercial health plans by Tennessee officials found that Express Scripts, one of the largest U.S. PBMs, violated state laws in its dealings with…
In an unusual move, an audit of commercial health plans by Tennessee officials found that Express Scripts, one of the largest pharmacy benefit managers in the United States, violated state laws in its dealings with pharmacies, according to newly released documents.
Specifically, the company failed to properly reimburse pharmacies, favored its own specialty pharmacy operations by paying higher dispensing fees than to other pharmacies, and did not properly handle appeals filed by pharmacies, according to the state Department of Commerce and Insurance, which audited transactions that Express Scripts handled for commercial health insurers in 2023.
For the moment, the state has not fined the company, although it may yet do so, according to a consent order. A department spokesperson declined to comment. However, the audit was released two months after Express Scripts had been ordered to pay a $250,000 fine for failing to reimburse a pharmacy. We asked the company for comment and will update you accordingly.
