Anthem Files Lawsuit Against Express Scripts Over Prescription Drug Prices

The Wall Street Journal: Anthem Sues Express Scripts Over Drug Pricing
Health insurer Anthem Inc. sued Express Scripts Holding Co. for about $15 billion in damages, alleging that the pharmacy-benefit manager violated their contract through excessive charges and failures in its operations. The lawsuit, filed on Monday in the U.S. District Court for the Southern District of New York, seeks damages tied to what Anthem said was Express Scripts’ unduly high pricing for drugs. Anthem also asked for a judgment that it could terminate its deal with Express Scripts, which stretches to 2019, but the insurer said it hasn’t determined if it would actually end the contract. (Wilde Mathews, 3/21)

NPR: Anthem Sues Express Scripts For A Bigger Slice Of Drug Savings
The battle over drug prices escalated Monday when health insurance giant Anthem Inc. sued Express Scripts, a manager of drug benefits, to get a bigger share of savings on prescription medicines. Anthem is looking for a change in its contract with Express Scripts, which handles drug benefits for 80 million people. The insurer says it's overpaying for pharmaceuticals and not benefiting from rebates the pharmacy benefit manager has negotiated with drugmakers. (Kodjak, 3/21)

The Washington Post: Anthem Sues Express Scripts Over Prescription Drug Pricing
Insurers contract with middleman companies like Express Scripts, which negotiate rebates and discounts on prescription drugs on behalf of the people they insure and pocket some of the savings for themselves. Anthem entered into a ten-year agreement with Express Scripts in 2009 that included a provision for a periodic review of pricing, to ensure that the prices Anthem received were competitive with others in the marketplace. According to the lawsuit, Express Scripts' current pricing for the contract now exceeds competitive pricing by $13 billion, plus an additional $1.8 billion through a transition period after the contract is terminated. (Johnson, 3/21)

The Associated Press: Anthem Sues Express Scripts Over Cost Of Prescriptions
Anthem said in a statement that Express Scripts was obligated to negotiate in good faith to make sure Anthem received competitive pricing, but that it had refused to do so. A spokesman for Express Scripts said that Anthem’s lawsuit had no merit, and that it had “consistently acted in good faith and in accordance with the terms” of its deal with Anthem. (3/21)

Bloomberg: Express Scripts Incoming CEO Wants Anthem To Stay, Despite Suit
Express Scripts Holding Co.’s incoming chief executive officer is trying to keep its biggest customer, after health insurer Anthem Inc. sued to recoup billions of dollars in what it called excess payments for drugs and threatened to end their relationship. “We don’t intend to lose Anthem. We’ll get through this,” Express Scripts President Tim Wentworth, who will take over as CEO in May, said in an interview. “We think we have done a great job for Anthem.” (Tracer and Langreth, 3/21)

Will the deal prompt other insurers to look closely at their contracts with pharmacy benefits managers? Modern Healthcare examines that and other possible reactions to the suit —

Modern Healthcare: Will The Anthem-Express Scripts Battle Change The PBM Landscape?
Anthem's legal strike against Express Scripts Holding Co. may spur other health insurance companies to re-evaluate their contracts with pharmacy benefits managers to see if they are getting shortchanged on drug savings. It could also allow Anthem and others to consider integrating drug benefits under their own corporate umbrellas. At a minimum, observers expect more calls for transparency throughout the drug pricing process, which often is shrouded in secrecy in the name of “trade secrets” and has become one of the most divisive issues in healthcare. (Herman, 3/21)