Dive Brief:
- Louisiana’s insurance department has issued Express Scripts a cease-and-desist order, alleging the pharmacy benefits manager failed to pay more than 1.3 million prescription insurance claims on time.
- The Office of Group Benefits, a Louisiana agency that provides health and life insurance to eligible state employees and retirees, also received a cease-and-desist. Express Scripts manages the OGB’s pharmacy spending.
- State officials began investigating Express Scripts in April after receiving multiple complaints from the Louisiana Independent Pharmacy Association over the Cigna-owned PBM’s handling of claims.
Dive Insight:
From January to July last year, Express Scripts allegedly failed to pay more than 1.3 million electronic claims on behalf of the OGB within the 15 day required timeline, according to an investigation by the Louisiana Department of Insurance.
The Louisiana Department of Insurance made the Dec. 29 cease-and-desist to Express Scripts public last week, just days before the company’s window to appeal the action closed.
The LDI did not respond to a request for comment by time of publication. However, the state could levy a fine of up to $100,000 on Express Scripts, or refuse to renew or suspend its contract with the state, according to the cease-and-desist.
“Louisiana health care providers are deserving of full compliance with Louisiana law relative to payments they are entitled to receive from insurers and the third-party administrators associated with them,” Louisiana Insurance Commissioner Jim Donelon said in a statement.
The order does not prevent Express Scripts from continuing to serve its clients, a spokesperson for the company told Healthcare Dive.
“At the heart of this notice is an isolated incident concerning the implementation of a former client. The error was corrected more than six months ago,” the spokesperson said.
PBMs are facing rising controversy for their role in rising drug costs, along with lawsuits from states over operational issues and accusations of overcharging.
Express Scripts — one of the largest PBMs in the U.S. — has been accused of bilking Ohio’s pension fund to the tune of millions in 2020. Payer Centene has shelled out hundreds of millions to settle pharmacy-related allegations in Arkansas, Illinois, Mississippi, New Hampshire, New Mexico and Ohio, and has a $1 billion-plus fund to resolve similar claims in other states.
Last year, federal regulators launched an investigation into PBMs, and required the six largest PBMs in the country to turn over detailed information on their business practices.
Editor’s note: This story has been updated to include a statement from Express Scripts.
