Drug distributors win landmark opioid case brought by West Virginia local governments

https://mountainstatespotlight.org/2022/07/04/drug-distributors-win-west-virginia-landmark-opioid-case/

The three largest drug distributors in the United States cannot be held liable for the opioid crisis that has racked Huntington and Cabell County, a federal judge has ruled.

Nearly a year after the landmark trial in Charleston ended, U.S. District Judge David Faber sided with the companies: AmerisourceBergen, Cardinal Health and McKesson. 

“The opioid crisis has taken a considerable toll on the citizens of Cabell County and the City of Huntington,” the judge wrote in his ruling. “And while there is a natural tendency to assign blame in such cases, they must be decided not based on sympathy, but on the facts and the law.”

The city and county had argued that the companies created a “public nuisance” because of the sheer numbers of opioid painkillers they shipped to the area over several years.

Lawyers for the drug distributors argued that West Virginia’s public nuisance law was meant to provide communities relief from situations like polluted air or water from a single factory or business. 

Faber agreed with the companies that the city and county shouldn’t be allowed to use the state’s public nuisance law that way.

The judge noted that none of the West Virginia cases involving the state’s public nuisance law was focused on the sale or distribution of a product, such as opioid painkillers. “The extension of the law of nuisance to cover the marketing and sale of opioids is inconsistent with the history and traditional notions of nuisance,” he wrote in the ruling.

He wrote that two lower court rulings, in Marshall and Boone counties, that did allow public nuisance law to be applied to opioid distribution were “not persuasive” and were inconsistent with how the state Supreme Court has interpreted the law.

“To apply the law of public nuisance to the sale, marketing and distribution of products would invite litigation against any product with a known risk of harm, regardless of the benefits conferred on the public from proper use of the product,” the judge wrote.

West Virginia opioid trial: Here are the closing arguments

 

As opioid epidemic raged, drug company executives made fun of West Virginians

The drug distributors also argued that they shouldn’t be held liable for the effects of the opioid epidemic, because all the companies did was supply prescription drugs to licensed pharmacies, as a result of doctors writing prescriptions.

“The volume of prescription opioids in Cabell/Huntington was determined by the good faith prescribing decisions of doctors in accordance with established medical standards,” Faber wrote. “Defendants shipped prescription opioid pills to licensed pharmacies so patients could access the medication they were prescribed.”

Lawyers for Cabell County and Huntington said that the companies shipped 81 million pills to a county with fewer than 100,000 residents over eight years. More than 700 people died of opioid overdoses in Cabell County between 2015 and 2020, according to the state Office of Drug Control Policy.

In their lawsuit, the city and county had asked for $2 billion from the drug distributors for a plan to, among other things, provide more behavioral health services and address the abuse of controlled substances through multiple generations.

On a state level, West Virginia had previously settled its lawsuit with the same three big drug distributors for a total of $73 million. But West Virginia counties, cities and other municipalities weren’t bound by that settlement.

They could have joined the national settlement with the drug distributors, and drug manufacturer Johnson & Johnson, that was proposed last year and finalized this February for $26 billion.

But Huntington and Cabell County officials, as well as dozens more across West Virginia, chose not to be part of the settlement and to pursue lawsuits against the drug companies.

Another trial, with dozens of West Virginia cities, towns and counties suing the same three big drug distributors, is scheduled to begin Tuesday in Charleston. Although this trial is in state court and being handled by Mercer Circuit Judge Derek Swope, many of the other participants, including the lawyers, are the same.

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Looks like some Medical Societies are starting to growing a “back-bone” and finding a “pair”…hopefully there will be more.

ACR Statement on Recent Events: The Patient-Doctor Relationship Must Be Preserved

The American College of Radiology^® (ACR^®) supports the privacy and integrity of the physician-patient relationship. Physicians have a responsibility to recommend appropriate care for all clinical circumstances based on the best available evidence and careful consultation with their patients. The relationship between physicians and their patients is sacred; it must not be jeopardized by non-medical outside interference, including federal, state and local government intrusions beyond public health measures. Instead, physicians, legislators, regulators and patients must work together to ensure access to safe, effective and equitable healthcare for all patients.

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https://youtu.be/zKEhmZe_w9o?t=180

I clipped this video to start at abt 3 minutes in the video… to what is the “meat of the matter’

This is a interesting quote from a “my body my choice” side of the political spectrum… I wonder what this person and others in our population with the same opinion, would say if/when they were asked about those same lawyers, bureaucrats & judges getting between a chronic pain pt and their doctor about if/how their pain is – or is not – treated ?

After all it is claimed that Congress is typically 40% attorneys and back in 1969-1970 that passed the Controlled substance act and it was signed into law by an attorney and the enforcement of this law was handed to the DOJ.  Back then – and some people still believe today – that addiction is a choice and there is no mental health issues involved. The only “tool” that the DOJ had to enforce this law, was jail or prison.

The CSA was passed about 4-5 yrs after the Civil Rights Law was passed and addressed discrimination against those with disabilities. I have seen videos of the Governors of NY & CALF, in particular, claiming that they are going to do whatever possible to not let any law get between a pt and their doctor.. in regards to abortions, but I have not heard these same Governors saying anything about chronic pain pts receiving appropriate care in regards to their pain management.

Unless things have changed in NY, that state several years ago imposed a “Rx opiate tax” on prescriptions. It would appear that the puritanical thread in our societal fabric causes bureaucrats to tax something if they can’t ban or abolish a particular product or activity… just look at tobacco, alcohol, gambling.  Over the last couple of decades, it would seem that the bureaucrats and certain GREEDY LAW FIRMS.. have decided that taxing is just not enough…now they are suing a industry for the perceived “damages” that the selling of a otherwise legal product has caused to individuals in our society , and our society as a whole.  I may be wrong, I have not seen any of the money collected from these law suits being shared with those individuals within our society that have theoretically harmed.  The Tobacco settlement in the late 90’s, where the final agreement… the bureaucracies were to put the money they shared into anti-smoking campaigns, nut many states just threw the $$ that they collected into their GENERAL FUND.

When the CDC 2016 opiate dosing guidelines were published, I did not see any state’s Attorney General going to court, to get those guideline declared unconstitutional. So the denial of care and discriminating against chronic pain pts.. is a bipartisan issue ? 

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Filing a Civil Rights Complaint

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There is more and more issues coming to light of how the PBM industry is extracting a “boat load’ of excessive profits from just about any entity/person within our medication distribution system from Medicare/Medicaid/Insurance, pharma, wholesaler, pt.  It is possible that there could be HUNDREDS OF MILLIONS OF DOLLARS INVOLVED in overcharging by the PBM industry.  The largest 4-5 PBM – now all owned by insurance companies – control some 85-90% of all prescriptions.

Perhaps this is how CVS Health is fighting back against what it appears to be some cost controls coming down on this Industry.  CVS Health owns 10,000 community pharmacies, specialty & mail order pharmacies, Aetna Insurance, Caremark PBM, Silver Scripts Part D.

According to this, it would appear that CVS Health makes so much money on filling prescriptions from kickbacks/discounts/rebates from the Pharmas and “spread pricing”  paying the pharmacy filling the pt’s Rxs a fraction of what they charge the final payer (Medicare/Medicaid/Insurance)… that they will “settle” with just collecting the insurance premium and forcing the pt to pay for the ENTIRE COST OF THEIR MEDICATIONS.  Just because you use a “cash Rx discount card”, doesn’t mean that a PBM won’t get a kickback/rebate/discount from a Pharma and/or collect you and your Rx information and sell all that data to some entity willing to pay for it.

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These two “bad boys” were caught in the possession of illegal Fentanyl tablets and charged with possession, transportation and selling of illegal drugs.  Apparently in CALF, those who are arrested are put thru some “risk assessment” by the county probation dept to evaluate if those arrested, if released on their own recognizance or kept in jail.  Apparently, it was decided that these two “bad boys” did not presented a risk to public safety. Perhaps it was determined that these two “bad boys” would cost the system too much money/time for.. law enforcement, jail, prosecutor, public defender, court cost on what is probably nothing more than a couple of “mules” transporting illegal fentanyl into our country.

It would appear that the DEA did not even bother to become involved with the violation of the Federal Controlled Substance Act.  In reality, the illegal Fentanyl tabs have no financial value, in fact may be more of a financial liability to any part of the bureaucracy that has to deal with these illegal drugs, for the cost of inventorying, storing and destroying the illegal drugs.   Perhaps, these two “mules” were not going to get paid until they delivered the illegal drugs to their final destination.

The traffic stop created a potentially large financial risk to the CALF bureaucracy, if the existing laws were enforced.  The bureaucrats most likely knew that what illegal fentanyl drugs they had seized, was perhaps a very small percentage of these sorts of illegal drugs that actually gets to our streets and these two “bad boys” had no money or assets worth confiscating. So they just turned them back to the street from where they came.

Alleged drug traffickers released from California jail days after caught with 150K fentanyl pills

https://www.ktvu.com/news/alleged-drug-traffickers-released-from-california-jail-days-after-caught-with-150k-fentanyl-pills

Two alleged drug traffickers in California who were arrested last week for being in possession of 150,000 fentanyl pills — enough to kill millions of people — were released back onto the streets, officials said.

Jose Zendejas, 25, and Benito Madrigal, 19, both from Washington, were arrested during a traffic stop-turned-drug bust in Tulare last Friday. They were booked into the Tulare County Pre-Trial Facility on charges of possession, transportation and selling of illegal drugs, officials said.

In a surprising twist of events, the two inmates were released just days later.

The Tulare County Sheriff’s Office received a court order to release both suspects from custody on their own recognizance,” officials said.

“All inmates booked into Tulare County jails are sent through what is known as the Risk Assessment Process through the Tulare County Probation Department. That ‘Risk Assessment’ is then sent to a judge with the court, who, then, determines whether or not the individual arrested is held on bail or if they are to be released,” The Tulare County Sheriff’s Office added.

Sheriff Mike Boudreaux said he strongly disagrees with the decision to release the traffickers, citing public safety concerns, but said his office was forced to comply with the court order.

Investigators seized 150 packages with 1,000 fentanyl pills in each – enough to potentially kill several million people. Officials aid each pill sells for about $5 – meaning the bust netted about $750,000 worth of deadly drugs.

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PBM: Unmask the Villains of Healthcare’s High Costs

https://practicingphysician.org/pbm-unmask-the-villains-of-healthcares-high-costs/

Would you like to lower healthcare costs, restore quality and improve choice? Yes? Then you MUST learn about Pharmacy Benefit Managers (PBMs).

If you look on the Fortune 500 top 12 companies, you will find three companies who own PBM. Dig deeper, and you’ll discover these companies are CVS  health, who owns the PBM CVS Caremark, United Healthcare who owns the PBM Optum Rx, and Cigna, who owns the PBM Express Scripts. These three PBM control 85% of the prescription drug market, and are the biggest revenue generators for their parent companies. 

For example, when the insurance company Cigna, purchased Express Scripts in 2019, their revenues tripled. Take a peek under the hood of CVS Health, and you will discover that CVS’s  PBM CVS Caremark is, to put it frankly, its prize cash cow, its biggest source of revenue.  Moo.  

Until recently, many Americans had no idea what a PBM was, and blamed insurance and pharma and physicians for the high cost of care. The truth is much more complicated, and those making the money don’t want you to pull the mask off the villain of high healthcare costs.  They aim to prevent  the Scooby Doo denouement and keep Americans from discovering the biggest, richest, most devious villains in the healthcare space are the PBM.

Some really important clues to why we should suspect that the PBM are villainous profiteers:

–    The PBM and insurance companies now own one another, and some, like the CVS Health empire, also own pharmacy chains

–    The PBM controls the pharmaceutical companies, by creating the formularies, aka the list of medications that the insurance companies will “cover”. Physicians play no part, nor have any say in  this choice.

–    The PBM can collect legalized kickbacks, called ‘rebates’ from pharmaceutical companies because the PBM were granted an exemption from the anti-kickback statute in 2003 by GW Bush’s HHS secretary. This anti-kickback exemption allows pharmaceutical companies to simply pay for placement on the formulary.  Americans are not necessarily getting the best medication, but the best med a legal bribe can buy.

–    There is no transparency for these kickbacks (aka rebates) but sources have revealed that in 2020, the total amount of kickbacks approached $200 BILLION (yes with a B).

–    PBM like CVS Caremark are now facing charges of preventing elderly Medicare patients, including those with End Stage Kidney Failure from access to affordable life sparing medications.

–    In multiple states, PBM have been found to be helping themselves to Medicaid money… not a small helping, either: In Ohio alone, the PBM subsidiary of Centene as well as CVS and Optum were pocketing $244million per year.

–    The big PBM that own pharmacies, like CVS are utilizing shady practices to put trusted Mom and Pop pharmacies out of business.    

–    In an NBC News exclusive with Cynthia McFadden, the PBM mail order pharmacies were found to be delivering ineffective medications.  One young pediatric patient with cystic fibrosis was hospitalized after wasting away because of medications delivered by PBM giant Express Scripts, whose agent pooh poohed the concerns of the patient’s mother.

Do you need to hear more? 

Yes, you need to understand who is granting more favors to the behemoth companies responsible for the maleficent behavior noted above.

Let’s look at several recent congressional bills in chronological order of passage. 

The Affordable Insulin Now Act was passed by the House and Lingers in the senate

Although those who support the bill  claim to have lowered the cost of insulin, Lloyd Dogget, a Texas Democrat correctly stated that the bill does not lower the cost of insulin by even a penny.  He’s correct.  It lowers the co-pay, but the uninsured, and those who pay insurance ( whether they be employer or independent purchaser)  will continue to pay the full bloated cost of insulin, 80% of which is flowing to the PBM via kickbacks and fees.  In other words, this bill simply ensures that the taxpayers keep paying the PBM in the form of kickbacks.

Worse yet, the bill grants a delay of the rebate rule for PBM.  The rebate rule was an Executive Order introduced in 2020 and demanded that the kickbacks (aka rebates) would flow to the patient at the point of sale and not the PBM and the insurers.  PBMs are continually telling Americans that they pass on the rebates, yet when the rebate rule was suggested, they have threatened to increase Medicare premiums as soon as the rule is enacted. 

Congress has discovered they can pull the entirely disingenuous accounting sleight of hand of delaying the rebate rule (in other words, allowing the PBM to keep collecting their kickbacks and not forcing them to pass on to patients) and thereby claiming that they are saving money by preventing Medicare premium increases. To put another way, the PBM’s and Insurers are playing Chicken with the rebate rule by threatening Medicare premium increases, and the Congress-people that delay the rebate rule are taking the bait.  I suppose that makes them lower than chickens in the game.  Perhaps they are simply chicken….. oh, never mind. Maybe they simply don’t understand.

The insulin Bill was not the first time Congress  delayed the rebate rule.  Apparently they did it in the infrastructure bill, too.  Howard Dean, a physician and former presidential candidate called them on it in Newsweek, even pointing out that the rebate rule was solid, and potentially the best thing to come from the Trump Presidency. 

Based on the above, we ought to let that insulin bill die and come up with a real way to lower insulin costs.

The recent Gun Bill Passed by the Senate and House and signed into law sneaked in a gift to PBMs.

Why on earth would a bill on guns contain another delay in the rebate rule, yet another gift to the PBM industry?  The same faulty accounting gimmick of using the rebate rule delay as a pay for.  Unbelievable.  Senators Chris Murphy, D-CT and John Cornyn, R-Tx are mum about who put the PBM poison pork into the gun bill.  Interestingly, Murphy’s top donor is the law firm that helps CVS negotiate mergers.  And Cornyn is a top taker from Vizient, a hospital Middleman Group Purchasing Organization.

Good news at last!  PBM reform in the Mental Health Package

Thankfully, some good news exists. .  Some colossally INCREDIBLE news:

HR 7666, the bipartisan mental health bill introduced by Frank Pallone, D-NJ, and Cathy McMorris Rogers –R, Wa passed the house this week with 400 yay votes.

Some of us were really yelling ‘Yay’ when we discovered splendid section 602, quietly added by Rep Michael Burgess (R-Tx), mandating   big time TRANSPARENCY for big PBM/Insurers with shocking penalties of $10K per day for non-compliance.

Requiring  PBM transparency will save $2BILLION/10 years, paying for the bill.  Billion with a ‘B’.  As Mental health and substance abuse medications are largely overpriced due to PBM kickbacks, this provision absolutely belongs in the bill.

Americans will receive  some wonderful services  with this bill for Mental Health and Substance Use Disorders. Full detail can be found in the bill,  but here is a screenshot of some of the high points

WE CANNOT STOP… we must make sure the mental health bill passes in the senate WITH PBM reform Intact. 

Please CALL and EMAIL  both of your US Senators ASAP, (find their numbers and email contact links  here ) and tell them to PASS  the Senate version of HR 7666 with the Burgess amendment to bring PBM transparency and accountability intact.  Ask  your friends to call.  Ask your neighbors to call. Ask everyone in your circle and beyond. Tell YOUR Senators you now know the PBMs are behind the ever increasing healthcare costs and it’s time for Congress  to listen to we the people and not the profiteering villainous Pharmacy Benefit Managers! 

Drs. Mass and Dewey are proud to be pediatricians for over 20 years each and fierce advocates for patients and physicians!

Dr. Mass, graduated from Duke Medical School and trained at Northwestern. She has practiced in the Philadelphia area. She’s a cofounder of Practicing Physicians of America And leadership in Free To Care .

Dr. Dewey attended Loyola University Stritch School of Medicine . She did a year of surgery internship then two years of pediatric surgery research before training in Pediatrics at University of Minnesota. She is founder and CEO of Peds Mama Doc and has published in multiple outlets

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Medicare plans to stop posting some hospital safety data

https://www.statnews.com/2022/07/01/medicare-wants-to-stop-publishing-some-hospital-safety-data-next-year/

After Ann MacDonald’s 82-year-old mother, Betty (above left), died in a Rhode Island hospital after developing sepsis after surgery, she has wondered about hospital safety. She turns to Care Compare, a federal government website that compiles hospital quality data in a user-friendly format, to look at its star ratings whenever she or a loved one needs hospital services. But Care Compare shrank during the pandemic, and Medicare, the federal agency that maintains the website, wants to trim even more of the measures from the data it’ll release next year.

Medicare proposes to keep under wraps a composite score made of 10 metrics of patient safety and adverse events, including pressure ulcers, hip fractures, and sepsis after surgery, the condition that killed MacDonald’s mother. Patient safety groups aren’t buying the agency’s argument that the change is fair given hospitals’ pandemic strain. STAT’s Tara Bannow explores.

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Just have someone (bureaucrat) with some degree of political power that has a family member that ends up abusing some potentially addictive substance and they will exercise any and all power/influence they can muster up to solve this problem – never mind that the particular family member has some undiagnosed/untreated mental health issues… they really will not publicly admit that fact.  Most will blame the SUBSTANCE that their relative is abusing/involved with.  So, even if there is a valid medical use for certain substances/medications…  the bureaucrat will attempt to eliminate/restrict EVERYONE’S access to this/these substance(s), even those who have a valid medical necessity to help optimize the person’s quality of life.

It would seem by this article that those Oregon bureaucrats want just about any/all state bureaucrats to have total access to the state’s PDMP.  Forget that this database contains a “boat load” of HIPPA PERSONAL PRIVATE HEALTH INFORMATION. To quote President Reagan, when your neighbor loses their job, we are in a recession, when you lose your job, we are in a depression .

State fails to enact majority of recommendations aimed to stem opioid misuse, audit says

A Secretary of State report says the state needs to do more to identify excessive prescribers and patients who “doctor shop”

https://oregoncapitalchronicle.com/2022/06/29/state-fails-to-enact-majority-of-recommendations-aimed-to-stem-opioid-misuse-audit-says/

As a deadly drug epidemic continues to rage in Oregon, state officials have only made a few changes recommended by the Secretary of State’s Office nearly four years ago to curb opioid misuse.

That was the overarching finding of an audit released Wednesday of the state’s Prescription Drug Monitoring Program, which tracks prescriptions of controlled substances, including painkillers, stimulants and tranquilizers. 

The report reviewed changes the state has made since the Audits Division of the Secretary of State’s Office first audited the program in December 2018. 

Over that time, the drug epidemic has worsened, and today poses a major threat to adolescents.

Secretary of State Shemia Fagan said during an online news conference that her mother became addicted and ended up homeless. Addiction, for her, is deeply personal, she said.

“These are people’s parents and kids and uncles and brothers and siblings and friends,” Fagan said. “Five Oregonians die a week from opioid related overdoses.”

When the 2018 audit was released, Oregon had the highest rate of seniors hospitalized for opioid overdoses, abuse and dependence. It had the sixth-highest percentage of teenage drug users.

Today, Oregon has the highest rate of misuse of prescription opioids in the country, the Secretary of State’s Office said in a statement.

“Although Oregon is dispensing fewer opioid prescriptions, it is still prescribing at a higher rate than the national average,” auditors wrote. “Additionally, there has been a steady increase in prescription stimulants.”

A practice of excessive prescribing of opioids dates to the 1995 federal approval of OxyContin and aggressive marketing by Purdue Pharma. In the more than two decades since, thousands of people have died across the country. Deaths in Oregon from overdoses and poisoning jumped from about 600 in 2018 to 700 in 2019 and 900 in 2020, Oregon Health Authority data show. 

While prescription opioids have contributed to the epidemic, the state is also grappling with a flood of fake fentanyl pills that are easily accessible on the streets.

In the 2000s, amid an opioid epidemic fueled by overprescriptions, various states created databases to track them as a way of limiting excessive prescribing of opioids. Fifty states now have a monitoring program but many have tighter rules than Oregon and they don’t have a drug problem as severe as Oregon, said Kip Mennott, the Secretary of State’s audit director. Tightening the program’s requirements will help stem the problem but it’s not the only answer, he said.

“This is not the entire drug epidemic – this is one part of it,” Mennott said.

Program’s requirements

The program requires pharmacies to file information about prescriptions of controlled substances. Prescribers are supposed to register so state officials can identify excessive prescribers. Prescribers also search the database to identify patients who “doctor shopped” to obtain more prescriptions than they need.

But Oregon providers are not required to check the database when they prescribe controlled substances, the latest audit said. This is something auditors recommended in 2018 and is common in other states.

The audit identified patients with opioid prescriptions from “excessive numbers of prescribers” and “dangerous prescription drug combinations,” which includes mixing opioids such as OxyContin with sedatives, like Xanax.

It also said that state laws prevent the database from being shared with health licensing boards and law enforcement to monitor and address questionable prescription activity, another area of concern. 

“Questionable prescribing habits seen within the data, even those that are egregious, cannot be elevated to any regulatory or enforcement entities to directly look into those situations,” the 2018 audit said.

Memmott, whose youngest brother has struggled with a lifelong drug addiction, said many of the changes needed are up to the Legislature. But he said the Oregon Health Authority has not taken an aggressive role in pursuing those changes.

“They feel like they’re limited, and they have other legislative priorities as well,” Memmott said. 

As a result, the Secretary of State’s Office is taking “a more active role” in lobbying lawmakers, including presenting the audit to the Legislature, Fagan said. She called on state lawmakers to pass the remaining changes recommended by the audit.

“We have to take full advantage of it,” Fagan said, referring to the program.

The health authority said in a statement that it values the state’s prescription monitoring program, noting it has reduced overprescribing.

“The agency is pleased with the performance of the (program) in ensuring appropriate use of prescription drugs, and helping people work with their health care providers and pharmacists to determine what medications are best for them,” the statement said.

But the agency will not play a major role in pursuing legislative changes.

“OHA appreciates that the Secretary of State auditors identified additional areas of improvement. However, many of the recommendations fall outside of the scope of OHA and require additional legislative changes,” the statement said. “The agency looks forward to working with the Oregon Legislature as potential statutory changes are considered in future sessions. The Legislature established the (the program) as a means for improving provider collaboration and patient outcomes, but the program is not a law enforcement, regulatory or insurance tool.”

The audit said five recommendations have not been implemented and three others 

• Develop a way for officials involved with Medicaid to query the database to allow them to monitor patient prescriptions for controlled substances statute
• Ask the Legislature to adopt a change in statute ensuring that prescribers register with the program as required and that pharmacies submit corrected data. 
• Ensure providers justify questionable prescribing practices and share potential signs of abuse, misuse or diversion of controlled substances with licensing boards and law enforcement. The health authority said it is “actively using appropriate channels” to recommend legislative changes.
• Expand the list of professional and state entities that can access the database. The health authority said it is “actively” involved in making this legislative change.
• Require prescribers to check the database before prescribing a controlled substance and require pharmacies to do the same before filling a prescription and periodically while the patient is on these medications. OHA staff said it is in the process of recommending that the Legislature make this change.

The three recommendations that have been partially implemented include expanding information that the database collects.

“We need more transparency,” Mennott said.

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PBM faces suit over alleged ‘refill pill mill’ scheme

https://ncpa.org/newsroom/qam/2022/06/29/pbm-faces-suit-over-alleged-refill-pill-mill-scheme

Express Scripts is facing a lawsuit under the False Claims Act on charges that it delivered pointless prescribed drugs to military personnel, bilking the federal authorities and distributors out of billions of dollars. A whistleblower claims the company’s software was allegedly set up to refill 90-day prescriptions on day 60, which means that

Tricare beneficiary obtained 73 percent more tablets than prescribed over the course of 12 months.

The suit was filed in a California federal courtroom in mid-2019 and unsealed earlier this month. Express Scripts inflated drug prices for payers and patients via its “refill pill mill” that systematically overcharged the Tricare program for treatment from October 2009 to March 2018, the suit alleges. NCPA has spoken out for years against mail-order pharmacy for many reasons, not the least of which is the waste it produces. Here’s a link to our Waste Not, Want Not document showing examples of this needless waste. If you have a photo to add, send it to Michael Rule.

According to  https://en.wikipedia.org/wiki/Express_Scripts  One of Express Scripts largest clients is the United States Department of Defense‘s Tricare program. and On March 7, 2018, it was announced that Cigna would buy Express Scripts in a $67 billion deal. The deal closed on December 20, 2018 at $54 billion, allowing Cigna to start offering new Express Scripts products to its corporate health insurance customers in 2019.

Maybe Cigna’s due diligence in looking into buying Express Scripts, exposed this “little systematic overcharging” of Tricare/Feds caused it to come to a end, because Cigna’s did not have anything to do with the financial liability tail attached to the Express Scripts deal.

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