Public officials continue to turn up the heat on pharmacy benefit managers. Less than a week after a U.S. Senate committee approved PBM reform legislation, the Ohio Attorney General has sued Express Scripts and Prime Therapeutics, alleging that the companies conspired to illegally increase drug prices.

"PBMs are modern gangsters," Attorney General David Yost said. "They were designed to protect and negotiate on behalf of employers and consumers after big pharma was criticized for overpricing medications, but instead they have absolutely destroyed transparency, scheming in the shadows to control drug prices on all sides of the market."

The lawsuit alleges that Express Scripts, one of the country's three largest PBMs, responded to criticism of its model by forming the group purchasing organization Ascent Health Services in 2019. It then granted Prime Therapeutics ownership in Ascent before moving its operations to Switzerland, which allowed it to further obfuscate its pricing models. The lawsuit also names Cigna Group, parent company of Express Scripts; Evernorth Health, another subsidiary of Cigna; Humana Pharmacy Solutions; Humana, parent company of Humana Pharmacy Solutions; and Ascent.