Categorical Scripts, Humana face price-fixing lawsuit in Ohio

Governmental stress on pharmacy profit managers continues to escalate, this time with Ohio Lawyer Common Dave Yost (R) alleging that three main corporations and a overseas group buying group colluded to repair prescription drug costs and reap the rewards.

In line with the lawsuit the legal professional common filed Monday, Cigna subsidiary Categorical Scripts and Blue Cross and Blue Protect-affiliated Prime Therapeutics labored with Switzerland-based Ascent Well being Companies to lift the costs of medication, together with insulin.

By means of Ascent Well being Companies, Categorical Scripts, Prime Therapeutics and Humana Pharmacy Options share drug pricing and rebate info and repair rebates and costs amongst themselves, Ohio alleges. Categorical Scripts based Ascent Well being Companies in 2019, Prime Therapeutics is a minority proprietor and Humana Pharmacy Options is a shopper.

Ascent Well being Companies, Cigna and its Categorical Scripts and Evernorth Well being subsidiaries, Prime Therapeutics, Humana and Humana Pharmacy Options are named as defendants. Prime Therapeutics declined to remark about ongoing litigation. The opposite corporations didn’t instantly reply to requests for remark.

Categorical Scripts is likely one of the three main PBMs together with CVS Well being’s Caremark and UnitedHealth Group’s OptumRx, which collectively management greater than 75% of the market. Yost claims within the lawsuit that Categorical Scripts leverages its market energy to create a “pay to play” rebate system that encourages drug producers to hike costs for higher placement on formularies.

“The price of Categorical Scripts’ supracompetitive earnings have been pushed onto these with the least energy—together with people whose prescription prices are calculated at, or as a proportion of, those self same rising record costs,” the lawsuit says. The doc, filed in Delaware County Frequent Pleas Courtroom, requires the defendants to halt “secret and anticompetitive conduct” that contributes to escalating drug costs.

These actions allegedly brought on the value of insulin to spike from about $20 per unit within the late Nineteen Nineties to between $300 and $700 per unit in 2023, in accordance with the lawsuit. President Joe Biden enacted a regulation final 12 months capping insulin prices at $35 a month for Medicare beneficiaries, and main producers Eli Lilly, Sanofi and Novo Nordisk subsequently adopted voluntary limits on costs for the diabetes remedy.

Federal and state regulators more and more are scrutinizing the actions of those so-called pharmaceutical market middlemen, together with a slew of lawsuits from states that allege PBMs are fleecing Medicaid.

Home Oversight and Accountability Committee Chair James Comer (R-Ky.) launched a probe this month into PBMs’ alleged anticompetitive practices. Comer is searching for info from CVS Caremark, OptumRx and Categorical Script. A Senate invoice would ban PBM “clawbacks” from pharmacies and require corporations to reveal spread-pricing schemes and pharmacy charges. The Federal Commerce Fee is also conducting an investigation into the PBM business’s results on pharmaceutical costs.