Express Scripts settles with NM, 28 other states

One of the nation's largest pharmacy benefits management companies has reached a settlement with New Mexico and 28 other states resolving claims of deceptive business practices.

Express Scripts Inc., which has more than 50 million customers nationwide, will be required to change its business practices and pay $9.3 million to the states and up to $200,000 in reimbursement to patients who incurred expenses related to certain switches between cholesterol-controlling drugs.

Express Scripts has also agreed to make a series of disclosures to consumers, doctors and employers about the company's business practices.

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Pharmacy benefits management companies work with health plans to process prescription drug claims, negotiate with drug companies to obtain discounts, negotiate discounts with participating retail pharmacies to provide dispensing services and dispense drugs to patients through the companies' own mail order pharmacies.

The states involved are Arizona, Arkansas, California, Connecticut, Delaware, District of Columbia, Florida, Illinois, Iowa, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nevada, New Mexico, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia and Washington.

The states alleged that Express Scripts engaged in deceptive business practices by not always acting in a manner consistent with its representations to consumers and employers about its pharmacy benefit management services. In particular, they alleged that Express Scripts may have overstated the cost benefits of switching to certain preferred medications.