{"id":46156,"date":"2022-07-14T03:01:34","date_gmt":"2022-07-14T01:01:34","guid":{"rendered":"https:\/\/pharma-trend.com\/en\/express-scripts-sued-by-ahf-over-claw-backs\/"},"modified":"2022-07-14T03:01:34","modified_gmt":"2022-07-14T01:01:34","slug":"express-scripts-sued-by-ahf-over-claw-backs","status":"publish","type":"post","link":"https:\/\/pharma-trend.com\/en\/express-scripts-sued-by-ahf-over-claw-backs\/","title":{"rendered":"Express Scripts Sued by AHF Over \u2018Claw Backs\u2019"},"content":{"rendered":"
\n

\nSweeping federal lawsuit, asserting 14 claims of violations of law in nine U.S. states where AHF operates pharmacies, was filed in federal court in St. Louis, MO<\/i>\n<\/p>\n

\nAHF asserts Express Scripts, a huge<\/i> pharmacy benefits manager, manipulates loophole in Medicare \u201cStar Ratings\u201d system as purported justification for \u201cclawing back\u201d millions of dollars of Medicare benefits from AHF pharmacies, creating higher profits for Express Scripts at the expense of patients<\/i>\n<\/p>\n

LOS ANGELES–(BUSINESS WIRE)–AIDS Healthcare Foundation (AHF<\/a>), the largest global AIDS organization, which cares for over 100,000 individuals living with HIV or AIDS in the United States, filed a lawsuit in the U.S. District Court for the Eastern District of Missouri, Eastern Division, against Express Scripts, one of the three dominant U.S. pharmacy benefits managers (PBMs), and a subsidiary of Cigna, the $47-billion global health-insurance behemoth. The case, AIDS Healthcare Foundation v. Express Scripts, Inc.<\/i> (Case No. 4:22-cv-00743<\/a>), was filed yesterday.\n<\/p>\n

<\/a><\/p>\n

\nAHF is the owner of the \u201cAHF Pharmacy\u201d chain of pharmacies, serving primarily people of limited economic means living with HIV\/AIDS. Because Express Scripts manages pharmacy benefits for \u2013 and effectively controls access to \u2013 tens of millions of people with health insurance in the United States, Express Scripts has much greater bargaining power than much smaller community and specialty pharmacies like AHF\u2019s (even in small chains). Express Scripts offers AHF and other pharmacies essentially \u201ctake-it-or-leave-it\u201d contracts with terms and conditions excessively favorable to Express Scripts and deleterious to AHF. Pharmacies like AHF must accept these contracts or lose access to countless patients.\n<\/p>\n

\nSpecifically, AHF asserts that Express Scripts manipulates the Medicare \u201cStar Ratings\u201d system \u2013 which is used to score insurance plans \u2013 to give unfairly low \u201cperformance\u201d scores to participating pharmacies, and that, as a result of these arbitrary low scores, the PBM then \u2018claws back\u2019 Medicare benefits from pharmacies\u2014often months and years after the fact\u2014actions that result in higher profits for Express Scripts at the expense of HIV\/AIDS and other patients served by AHF and other independent and mom-and-pop pharmacies.\n<\/p>\n

\n\u201cAHF brought this civil action to recover many millions of dollars taken by Express Scripts, purportedly pursuant to unconscionable contracts with AHF yet in violation of those very contracts and the covenant of good faith and fair dealing implied in those contracts, among other violations of AHF\u2019s rights,\u201d said Andrew F. Kim<\/b>, AHF\u2019s lead counsel on the matter.\n<\/p>\n

\nAHF asserts 14 counts of Express Scripts law violations in nine U.S. states where AHF operates pharmacies. Among the counts are \u201cunfair\u201d or \u201cdeceptive\u201d trade or business practices in California<\/b>, Florida<\/b>, Louisiana<\/b>, New York<\/b>, and Washington<\/b> state. Five other counts assert violations of \u201cany willing provider\u201d laws in Georgia<\/b>, Illinois<\/b>, Louisiana<\/b>, Mississippi<\/b>, and South Carolina<\/b>.\n<\/p>\n

\nAHF is demanding a jury trial in the case, which was filed by AHF in-house counsel and Kim Riley Law.\n<\/p>\n

\nAIDS Healthcare Foundation<\/b> (AHF), the largest global AIDS organization, currently provides medical care and\/or services to over 1.6 million individuals in 45 countries worldwide in the US, Africa, Latin America\/Caribbean, the Asia\/Pacific Region and Eastern Europe. To learn more about AHF, please visit our website: www.aidshealth.org<\/a>, find us on Facebook: www.facebook.com\/aidshealth<\/a>, follow us @aidshealthcare<\/a> or subscribe to our AHF podcast \u201cAHFter Hours.\u201d<\/a>\n<\/p>\n

Contacts<\/b> <\/p>\n

\nMEDIA CONTACTS:
\n
Ged Kenslea<\/b>, Senior Director, Communications, AHF, +1.323.791.5526 [cell] +1.323.308.1833 [work] gedk@aidshealth.org<\/a>
Jonathan M. Eisenberg<\/b>, Deputy General Counsel–Litigation for AHF, +1.323.860.5361 [work] jonathan.eisenberg@ahf.org
\n<\/a>
Kirra N. Jones<\/b>, Assistant General Counsel for AHF, +1.323.860.5320 [work] kirra.jones@ahf.org<\/a>\n<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Sweeping federal lawsuit, asserting 14 claims of violations of law in nine U.S. states where AHF operates pharmacies, was filed in federal court in St. Louis, MO AHF asserts Express Scripts, a huge pharmacy benefits manager, manipulates loophole in Medicare \u201cStar Ratings\u201d system as purported justification for \u201cclawing back\u201d millions of dollars of Medicare benefits … [Read more…]<\/a><\/span><\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13],"tags":[],"class_list":{"0":"entry","1":"post","2":"publish","3":"author-business","4":"post-46156","6":"format-standard","7":"category-industry"},"yoast_head":"\nExpress Scripts Sued by AHF Over \u2018Claw Backs\u2019 - Pharma Trend<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pharma-trend.com\/en\/express-scripts-sued-by-ahf-over-claw-backs\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Express Scripts Sued by AHF Over \u2018Claw Backs\u2019 - Pharma Trend\" \/>\n<meta property=\"og:description\" content=\"Sweeping federal lawsuit, asserting 14 claims of violations of law in nine U.S. states where AHF operates pharmacies, was filed in federal court in St. Louis, MO AHF asserts Express Scripts, a huge pharmacy benefits manager, manipulates loophole in Medicare \u201cStar Ratings\u201d system as purported justification for \u201cclawing back\u201d millions of dollars of Medicare benefits ... 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