Cigna/Express Scripts

Deep inside the gun bill: a break for drug middlemen

BY: - June 22, 2022

Many Americans across the political spectrum are clamoring for federal action on guns in the wake of a mass shooting at an Uvalde, Texas, elementary school, a Buffalo, N.Y., grocery store and hundreds of other mass shootings. But buried in a bipartisan compromise hashed out by the U.S. Senate on Tuesday is an unrelated provision they might not be so happy about. Apropos of nothing, the gun bill would enhance the exemption drug middlemen working with Medicare have from the federal "Anti-Kickback Statute." 

Feds to probe drug rebates

BY: - June 20, 2022

The Federal Trade Commission last week announced what some observers believe could be a game-changer when it comes to the rising cost of prescription drugs. The agency — which is meant to protect fair competition — said it would look into the murky practice by which drugmakers grant rebates and other fees to insurer-owned pharmacy […]

Federal Trade Commission to investigate pharmacy middlemen

BY: - June 9, 2022

After years of pleading, the Federal Trade Commission on Tuesday voted to investigate the practices of some of the nation’s largest companies. They’re accused of using their dominance in myriad sectors of the health care space to drive up costs, drive out competition and reap profits. Four of the six companies to be investigated have […]

After years, pharmacy-middleman suit might finally come to trial

BY: - May 16, 2022

Since at least 2016, Ohio pharmacists have been accusing large companies acting as pharmacy middlemen of abusive practices, which they deny. And since 2019, the state has been accusing them as well, in the form of lawsuits. Now, after years of wrangling in court, some of that litigation might be headed to trial. The middlemen, […]

Attorney General seeks financial info from Medicaid contractors

BY: - March 11, 2022

In the past month, Ohio Attorney General Dave Yost has sought financial information from the state’s five managed-care contractors, documents received in response to an open-records request show.  The AG won’t discuss ongoing investigations, but he might be looking into whether some practices by subcontractors who manage pharmacy benefits violate state law or federal regulations. […]

State employee pension fund to audit big PBM

BY: - March 11, 2022

The upcoming audit will be the fifth time in 10 years that the pharmacy benefit manager to the Ohio Employees Retirement System has been audited. An earlier version of this story said it had been audited more frequently. It’s been updated. The Ohio Employees Retirement System is seeking proposals for a firm to audit Express […]

Insurers slam critical drug-pricing research but can’t vouch for their own

BY: - December 9, 2021

A spokeswoman for a major health-insurance industry group on Wednesday questioned research cited in a story published Tuesday in the Capital Journal. In doing so, she cited a bit of purported research that she couldn’t vouch for herself. The story was about research showing that insurers working with Medicare are supposed to be lowering care […]

For one drug at least, biggest insurers force Medicare patients to buy the most expensive

BY: - December 7, 2021

In theory, the point of managed care is to save money by negotiating with providers for lower prices. So it would seem that the biggest managed-care providers would use their clout to negotiate the lowest prices from doctors and hospitals and for medicine. But for at least one drug, the largest Medicare managed-care companies are […]

Congressional group takes up PBMs, strikes a partisan tone

BY: - November 26, 2021

Members of Congress last week took up an issue potentially of great importance: What to do about powerful health conglomerates who play an increasingly powerful role in the drug-supply chain. But the event also demonstrated the harsh partisanship that increasingly paralyzes Congress in the face of difficult problems. Rep. James Comer, R-Ky, called the forum […]

CVS sometimes forces people to use its pharmacies. Now the Supreme Court will weigh in

BY: - November 5, 2021

It’s a practice long complained of in Ohio. CVS Health and other massive corporations often use their pharmacy middleman subsidiaries to force people to get the most expensive class of drugs from the businesses’ own mail-order pharmacies. Some call the practice “patient steering.” CVS and companies such as UnitedHealth and ExpressScripts/Cigna say the arrangements save […]

State says Medicaid director complied with ethics law, won’t share documents

BY: - October 11, 2021

The Ohio Department of Medicaid and the governor’s office last week insisted that Medicaid Director Maureen Corcoran complied with state ethics laws as her department entered into massive contracts earlier this year. However, they so far have refused to produce copies of affidavits that seem to be required by state law, and Corcoran is refusing […]

Ohio’s Medicaid director owns the stock of some major contractors, but won’t say how much

BY: - October 6, 2021

Since she became director of the Ohio Department of Medicaid in January 2019, Maureen Corcoran has owned stock in some of the department’s biggest contractors. Given the size of those contracts, they could have increased the value of the stock Corcoran owned. But while she complied with one set of state disclosure requirements, Corcoran won’t […]