The West Virginia Office of the Insurance Commissioner has issued a series of penalties, including a $1.5 million fine, to Express Scripts (ESI) for multiple violations identified in an Examination Report that reviewed claims between Jan. 1, 2023, and June 1, 2024.
Among the violations, ESI audits recouped more money from pharmacies than the harm associated with the dispensed product. ESI also did not reimburse pharmacies at the required rate of NADAC plus $10.49 while reimbursing their owned or affiliated pharmacies more than others. They also continued to designate specialty drugs in an unreasonable manner.
Among the provisions of the Agreed Order were a $1.5 million administrative penalty, corrected reimbursement with interest, and a corrective action plan. Read more about the Examination Report and Administrative Action here.
