Express Scripts Breaks Tennessee Law, Canada Investigates Express Scripts, States Battle PBMs...Like Express Scripts

Hey all,

Happy Hump Day! Today we have three stories about efforts to tackle PBM misconduct. Hopefully those efforts result in actual reforms (I’m not holding my breath). Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(STAT News) Tennessee Audit Finds Express Scripts Violated State Pharmacy Laws

In a groundbreaking audit, Tennessee officials concluded that Express Scripts, one of the largest pharmacy benefit managers (PBMs) in the U.S., violated state laws by unfairly reimbursing pharmacies, favoring its own specialty pharmacy, and mishandling appeals. This marks the first time a state insurance department has scrutinized a PBM’s conduct in commercial plans, reflecting growing concerns over the opaque influence of PBMs on drug pricing and access. Because clearly, with billions of prescriptions and decades of complaints, there was just never a good time to look into it before now. Full Article

(BenefitsPRO) and Express Scripts Canada Investigation

Express Scripts Canada is under investigation by the Competition Bureau for allegedly engaging in anti-competitive practices such as patient steering and margin-squeezing that hurt independent pharmacies. The probe, initiated after a complaint by the Canadian Pharmacists Association, questions whether ESC used its dominant PBM position to push patients toward its own pharmacies and burden competitors with high fees and audits, potentially violating Canada’s Competition Act. Looks like the U.S. doesn’t have a monopoly on Express Scripts making life miserable—we exported their misconduct to Canada (USA USA USA). Full Article

(HEALTH CARE un-covered) State-Level Reforms Targeting PBMs

A growing bipartisan rebellion against pharmacy benefit managers (PBMs) is gaining momentum across U.S. state capitals, with lawmakers in Alabama, Arkansas, California, and North Carolina introducing aggressive legislation to protect patients and preserve independent pharmacies. These reforms—ranging from banning PBM-owned pharmacies in Arkansas to criminalizing spread pricing in California—are a response to PBMs’ opaque pricing schemes that inflate drug costs and force small pharmacies out of business. And sure, a patchwork of state rules sounds messy—but if physician licensing has taught us anything, it’s that fragmented systems are super efficient and never confusing at all. Full Article