A group of pharmacy benefit managers (PBMs) have been named in a lawsuit that alleges the defendants have engaged in a 'multi-tiered fraudulent scheme' designed to raise the prices of EpiPen epinephrine injectors.
Express Scripts Holding Company, Express Scripts, Inc., UnitedHealth Group, Inc., OptumRx, Inc., and Prime Therapeutics, LLC, a group of pharmacy benefit managers (PBMs), have been named in a lawsuit that alleges the defendants have engaged in a “multi-tiered fraudulent scheme” designed to raise the prices of EpiPen epinephrine injectors. PBMs, according to the case, are responsible for determining what prescription drugs and medicines are sold to consumers, meaning they can “steer business from one manufacturer to another” based on kickbacks paid to them by the makers of each drug. The suit alleges that the defendants have conspired with Mylan Pharmaceuticals, Inc. and its affiliates – the makers of EpiPen – to raise the prices of the medicine to boost sales and allow Mylan to pay larger kickbacks to the PBM defendants. From the complaint:
“Mylan maintains the ability to sell EpiPen products to the millions of Americans who depend on them, without having to lower the ‘real,’ net prices to gain market share via formulary inclusion. Instead, they bargain for that market share by providing ever-larger rebates and other kickbacks to PBMs and entering into exclusive relationships with those PBMs, inflating the prices paid by consumers for EpiPens in order to preserve their net realized price and sales volumes.”
As a result of this “scheme,” the suit attests, consumers have been forced to pay inflated prices for life-saving medicine, which the complaint notes have increased from about $57 per EpiPen in 2007 to $608 in 2016.
The case, originally filed in Kansas federal court in August 2017, has since been transferred to Minnesota federal court.