Pharmacy Benefits Manager to Pay $3.2 Million for Overcharges On Workers’ Compensation Prescriptions

Various Injured Worker Prescriptions Filled in Springfield, Boston, and Worcester at Walgreens, CVS, and Rite Aid locations

The Pharmacy Benefits Manager, Express Scripts, Inc., has agreed to pay $3.2 million as part of an assurance of discontinuance filed in Suffolk Superior Court. The Attorney General Maura Healey’s Office alleged that Express Scripts overcharge for injured workers, by failing to follow prescription pricing procedures resulting in overcharges in the workers’ compensation insurance system.

“Employers need a workers’ compensation system that is functional, transparent, and affordable,” said AG Healey. “Our office will take action to ensure pharmacy benefits managers follow procedures and do not drive-up costs in our workers’ compensation system.”

Under the Commonwealth’s Workers’ Compensation system, when employees are hurt on the job, they are entitled to lost wages, compensation for injuries, and payments for certain injury-related expenses. The system sets limits for the cost of prescriptions for injured workers and requires companies to validate prices against certain regulatory benchmarks before processing their charges.

As outlined in the assurance of discontinuance, the AG’s office says that in certain circumstances Express Scripts failed to apply various regulatory benchmarks – like the Federal Upper Limit for Medicare and the Massachusetts Maximum Allowable Cost – to its pricing determinations for certain workers’ compensation insurance prescription drug charges. According to the settlement, these failures allegedly occurred on various injured worker prescriptions filled in Springfield, Boston, and Worcester at Walgreens, CVS, and Rite Aid locations.

Under the settlement terms agreed to by the parties, Express Scripts has agreed to pay $3.2 million for the alleged overcharges to the workers’ compensation system, in addition to implementing new procedures to prevent future overcharges in the workers’ compensation insurance system. The settlement also ensures that Express Scripts will cooperate with the AG’s Office’s monitoring of the company’s future regulatory compliance.

This case is part of an ongoing review by the Attorney General’s Office into prescription pricing procedures in the workers’ compensation system. AG Healey has now reached settlements with Express Scripts,Optum Rx, Walgreens, Stop & Shop, and United Pharmacy for workers’ compensation drug pricing violations totaling approximately $16 million.