- Major insurer Anthem filed suit Monday against its pharmacy benefit management vendor Express Scripts to recover damages for pharmacy pricing. Anthem alleges Express Scripts priced higher than "competitive benchmark pricing."
- The lawsuit also seeks a declaration of Anthem’s right to terminate its contract with Express Scripts, although the insurer has not made a decision whether to end its relationship with the PBM.
- For its part, Express Scripts believes the suit is without merit and that it has acted within the framework of its agreement with Anthem.
Anthem alleges it has attempted to negotiate with Express Scripts on benchmark pricing for more than a year to no avail.
"Under the agreement, Express Scripts is obligated to negotiate in good faith to ensure Anthem is receiving competitive benchmark pricing. Anthem has worked hard for more than a year to try to get Express Scripts to engage in such good faith negotiations, but Express Scripts has refused to do so," Anthem said.
In a statement, Express Scripts pushed back against Anthem's claims."Express Scripts values its relationship with Anthem and will continue to honor its commitments under the contract, as we would do with any client. Express Scripts has consistently acted in good faith and in accordance with the terms of its agreement with Anthem. We believe that Anthem’s lawsuit is without merit," said Jennifer Luddy, a spokesperson at the PBM.
The seeds of the suit were sown this past January when Anthem CEO Joseph Swedish went threatened a breakup with the major PBM during the JP Morgan Healthcare Conference in San Francisco.
"We are entitled to improved pharmaceutical pricing that equates to an annual value capture of more than $3 billion," said Swedish during an investor presentation at the time. "To be clear, this is the amount by which we would be overpaying for pharmaceuticals on an annual basis."
Express services the prescription drug benefits portion of Anthem members' plans. According to Reuters, the current ten-year contract runs through 2019.
The suit was filed in the U. S. District Court for the Southern District of New York.