Express Scripts Sues Maker of Overdose Drug, Intensifying Feud

The lawsuit, though heavily redacted, provides some tantalizing details about Express Scripts’ business dealings. Consultants along with also brokers — who advise employers on their prescription drug plans — said This kind of showed in which Express Scripts will be collecting fees in which keep rising as drug prices go up.

For example, according to the lawsuit, which was filed in federal court in St. Louis, Express Scripts charged Kaléo “administrative fees” in which climbed sharply at the same time in which Evzio was rising in cost. In January 2016, Evzio carried a list cost of $937.50 For just two injectors, along with also Express Scripts billed Kaléo for about $25,000 in administrative fees for its commercial clients. yet three months later, Evzio’s cost had climbed to $4,687.50, along with also these fees totaled nearly $130,000. in which’s on top of charges in which included “formulary rebates,” or drug discounts, along with also “cost protection rebates,” which are triggered when a drug jumps in cost. Those cost-protection rebates totaled $14 million — most of the money in which Express Scripts will be trying to recoup.

Benefit managers like Express Scripts typically pass the rebates they collect via manufacturers along to their clients — insurers along with also large employers — after taking a portion of the rebates for themselves. yet critics, like Linda Cahn, the chief executive of Pharmacy Benefit Consultants in Morristown, N.J., say in which the benefit managers are not transparent about what share of fees they keep, along with also what share they pass along to clients.

Administrative fees are particularly murky, she along with also others said. Some of the fees are passed to clients, yet benefit managers also collect various other fees in which are not returned to clients.

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Linda Cahn, the chief executive of Pharmacy Benefit Consultants, at home in Morristown, N.J., on Tuesday. She said in which benefit managers were not transparent about what share of fees they keep.

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Bryan Anselm for The completely new York Times

“The lawsuit reveals in which Express Scripts will be collecting immense sums of money. No one knows what they’re passing through along with also what they’re retaining,” said Ms. Cahn, who flagged the lawsuit in a note to clients Monday. “Every client along with also the federal government along with also taxpayers should insist in which they do.”

yet Brian Henry, a spokesman for Express Scripts, disagreed with her assessment along with also described Kaléo as a “deadbeat dad.” “They owe rebates along with also administrative fees in which we share with our clients along with also we are working to get in which money back,” he said in a statement.

Mr. Henry also said, “The vast majority of the administrative fees are passed back to our clients along with also inside the Medicare space, they are all passed on. Where they are not passed back, This kind of will be with the full knowledge along with also agreement of our clients.”

Spencer Williamson, the chief executive of Kaléo, said in a statement in which the lawsuit was “baseless” along with also in which the company was committed to providing affordable access to its drug “without burdensome paperwork or high out-of-pocket costs.”

The lawsuit will be the latest piece of bad news for Kaléo, a private Virginia company with just two products on the market. When Evzio arrived on the market in 2014, This kind of was sold as an easy-to-use device, similar to an EpiPen, in which could be stowed in a pocket or medicine cabinet along with also quickly used by friends or relatives to reverse the effects of a drug overdose.

yet while the device was initially hailed by addiction experts who said This kind of could make This kind of easier to stop fatal overdoses, the company came under heavy criticism in 2016, when This kind of quintupled the cost of Evzio. The cost increase — which came inside the midst of a national opioid abuse epidemic — prompted letters via members of Congress, demanding to know what had prompted the change.

Kaléo has said This kind of sharply raised the cost of Evzio to cover the cost of a completely new patient-assistance program in which lowers the out-of-pocket costs for people who cannot afford the product. Kaléo covers all of the out-of-pocket costs for patients with private insurance, along with also offers Evzio free of charge to uninsured people who make less than $100,000 a year.

yet critics have said in which such patient-assistance programs serve to drive up the cost of drugs to the health care system because while they ease the burden on patients, they leave insurers with the bulk of the bill, especially when a less expensive alternative will be available. various other forms of naloxone, the active ingredient in Evzio, are available at a much lower cost.

This kind of will be not the very first time Express Scripts has sued a drug maker with expensive products. In 2015, Express Scripts filed suit against Horizon Pharma, also over unpaid fees. Horizon agreed to pay Express Scripts $65 million in September 2016 to settle the case. After initially dropping coverage of Horizon’s drugs, Express Scripts added them back to its preferred drug list.

Express Scripts will be also being sued. Last year, the insurance giant Anthem sued Express Scripts in federal court in completely new York for $15 billion along with also claimed the company had been overcharging This kind of for drugs. Express Scripts, which denied the claims, said recently in which This kind of could most likely lose Anthem, its largest customer, beginning in 2020, leading to speculation about how the company will replace the business This kind of will be losing.

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Express Scripts Sues Maker of Overdose Drug, Intensifying Feud

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