AIDS Healthcare Foundation filed a lawsuit July 12 in St. Louis federal court against Cigna subsidiary Express Scripts for allegedly manipulating Medicare star ratings against pharmacies to "claw back" Medicare benefits at the expense of AHF patients.
Los Angeles-based AHF is the world's largest AIDS organization and cares for more than 100,000 Americans with HIV/AIDS, according to a news release.
AHF claims the PBM scored participating pharmacies with low Medicare star ratings performance scores so that it could claw back benefits from those pharmacies, resulting in higher profits.
The lawsuit alleges Express Scripts violated the law 14 times in nine states where AHF operates pharmacies, including unfair or deceptive business practices and violations of "any willing provider" laws. The company is seeking a jury trial.
"AHF 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's rights," Andrew Kim, AHF's lead counsel, said.
Becker's has reached out to Express Scripts for comment and will update this story if more information becomes available.