The Wall Street Journal
A lawsuit commenced by Quadrino Law Group on behalf of compound pharmacies against the nation’s leading pharmacy benefits manager, Express Scripts, was featured in the Wall Street Journal. The filing of the case drew the attention of numerous national media outlets, including Bloomberg, Yahoo Finance, and others.
The lawsuit alleges that Express Scripts is in violation of the ERISA claims regulation that governs all of the group health plans in the United States. An Express Scripts internal document revealed that the pharmacy benefits manager is engaging in cost cutting measures by targeting the pharmacies’ products as “not covered” due to “plan exclusions” that have not been identified at the time of the claim denials. By alleging that various health plans now exclude payment for compound ingredients, the claim denials legally need to be accompanied by an explanation and identification of what health plan amendments were made, if any, to a patient’s plan such that compounds and ingredients that were routinely covered and paid are supposedly not now covered.
The lawsuit alleges that either no plan changes were made or that any attempted changes were not lawfully carried out such that all claims for these medications must be paid in full.
Quadrino Law Group filed the case in the Eastern District of Missouri, the federal court that sits in St. Louis.