Express Scripts

A federal judge blocks a four-year limit on stays for international students and trainees.

A group of Arkansas independent pharmacies sue Express Scripts, alleging underpayment.

And a not-for-profit Medicare Advantage carrier broadens its plan offerings with a retail giant.

Those stories and more coming up.

It's estimated that there are nearly 17,000 physicians in the United States on J-1 visas participating in residency and fellowship programs.

A new Arkansas law targeting pharmacy benefit managers is getting its first test in court.

Twelve independent pharmacies filed a lawsuit in a St. Louis circuit court alleging that Express Scripts, which is part of Cigna, repeatedly reimbursed them less than what they were paid to acquire prescription drugs.

Arkansas law requires PBMs to reimburse pharmacies at no less than the national average drug acquisition cost, a federal benchmark based on what pharmacies pay to acquire prescription drugs.

thing with like big PBM.

Like you choose CBS, you choose Express Scripts, you know, you choose OptumRx, you kind of know what you're signing up for.

Yeah, you have maybe some stability and you have the ability to cover your, you know what, but you're going to be paying way more and it's not a good fiduciary strategy.

Yeah.

And multiple times it's been like, hey, you can join and you can sit on a committee, but it's $180,000.

And you'd sit on the committee with Express Scripts and CVS, Caremark.

And it was just everything was misaligned.

Oh, you could speak to the employers.

It was started back in the 80s, 90s with central fill operations for the VA so that they could become more efficient.

There were a few companies around like Express Scripts, and then you started to see some of the PBMs get into the mail order.

And Central Phil was talked about, but it was not really embraced completely like we're seeing today.

Fast forward past COVID, we saw obviously patients were unable, not willing to go to the pharmacy.

And so we stepped into it and really embraced it wholeheartedly.

Now, we're not new to this.

Twenty years ago, we built one of the first high-volume dispensing systems for express scripts.

And then CVS came along and they tapped us and said, we'd like to use that as well as we're starting up our mail order facilities.

Welcome to Future Ready Leadership.

My guest today is Adam Kotzner, President of Evernorth Care Management and Express Scripts and EVP of Customer Personalization for the Cigna Group.

Adam, thank you for joining me.

Thanks for having me, Jacob.

And our goal is to improve the access and affordability of medications for patients.

And I'm a pharmacist by training.

I have been in the industry for over 25 years, been in Express Scripts for about 18 years now and in role.

over three years in leading this organization.

Like you're not getting in this network.

And I was like, well, what are you doing over there that's your whole thing is to contract for me like and then i you know i reach out to express scripts whoever myself and i get nothing back from them so yeah it's cool that your psaos actually do something because mine does nothing they actually send me like a multiple choice question every year i have to do this attestation it's like how much are you comfortable losing but yeah my psao experience has been fully negative from the start so

And the rates are all lower than what you can buy drugs for, too, which doesn't make any sense.

I'm right there with you.

I see.

So I have a question.

We hear this a lot at PUT, and what you're describing happened, I want to say, two years ago with another PSAO and Express Scripts.

It was negotiations broke down at the last minute, and then Express Scripts just right, literally within seconds of that breaking down, had sent out these standalone contracts, which were far worse for the pharmacies than what the PSAO was negotiating.

These initiatives reflect a broader trend towards reducing healthcare's carbon footprint, highlighting the sector's role in addressing climate change.

Finally, regulatory landscapes continue to evolve with legal challenges as Florida's Attorney General sues express scripts and prime therapeutics.

Over alleged price fixing, this lawsuit underscores ongoing scrutiny over pharmacy benefit managers' practices, potentially prompting regulatory reforms to ensure fair pricing mechanisms within the pharmaceutical supply chain.

Overall, these developments illustrate a dynamic landscape where scientific innovation and regulatory maneuvers intersect to shape future pharmaceutical and biotech trajectories.

The state has filed a suit against two pharmacy benefit managers, alleging they colluded over the past few years to fix prices and underpay Florida pharmacies.

Attorney General James Uthmeyer says he's targeting Prime Therapeutics and Express Scripts.

Back in December 2019, these two companies announced a collaboration.

It was not a merger.