Vermont sues Caremark, Express Scripts, accusing PBMs of driving up prescription prices
Democratic Attorney General Charity Clark said CVS Health's Caremark, Cigna Group's Express Scripts and several of their affiliates pushed patients toward more-expensive drugs even when less-expensive alternatives were available.
Vermont this week became the latest in a growing number of states to sue leading pharmacy benefit managers, accusing them of driving up prescription drug prices for patients in to enrich themselves.
Democratic Attorney General Charity Clark said CVS Health’s Caremark, Cigna Group’s Express Scripts and several of their affiliates pushed patients toward more-expensive drugs even when less-expensive alternatives were available, and then pocketed the extra cost through an opaque system of fees. The lawsuit alleges that these companies violated Vermont’s Consumer Protection Act by manipulating the marketplace and reducing access to certain prescription drugs, including lower-cost drugs, through a series of tactics, with no transparency in their decision-making process.
“While the PBMs named in our lawsuit claim they perform their services on behalf of their clients and patients to lower prescription drug prices and promote patient health, that is just not true,” Clark said. “Instead, they have distorted the market to line their own pockets at the expense of Vermonters. My office is suing to bring transparency to prescription drug pricing and to hold these PBMs accountable.”
Clark is seeking a court order ending the allegedly illegal practices and an unspecified amount of damages. Express Scripts and Caremark are the largest PBMs in Vermont and control approximately 95% of the commercial market in the state, she said. As a result, they have a hand in nearly every prescription transaction and have near complete control over pricing, dispensing and reimbursement systems.
“It is unconscionable that PBMs are lining their pockets with misleading costs and fees dressed up as rebates,” Clark said. “They are keeping prescription drug prices astronomically high. They are manipulating the availability of lifesaving medications.”
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CVS spokesperson Mike DeAngelis countered that PBMs bring down costs by negotiating with drugmakers and do not determine what prices are charged by manufacturers. He said the company intended “to vigorously defend against this baseless suit.”
Vermont joins Hawaii, California, Ohio and Kentucky among states that have brought lawsuits over the business practices of PBMs. The Federal Trade Commission also is expected to sue the three largest PBMs (Caremark, Express Scripts and UnitedHealth Group’s OptumRx) over their role in negotiating insulin prices. These three companies comprise about 80% of the U.S. PBM market.