Express Scripts Tricare False Claims Act lawsuit dismissed


A federal judge has dismissed a False Claims Act case against Express Scripts that accused the pharmacy benefit manager of providing excessive and medically unnecessary prescription drug refills to military personnel and families and scamming taxpayers out of billions of dollars.

Judge Todd Robinson of the U.S. District Court for the Southern District of California wrote in a filing submitted Friday that the dismissal was warranted under the public-disclosure bar, meaning similar claims were made public prior to the lawsuit.

A pharmacist formally employed by Express Scripts, a Cigna subsidiary, alleged that the company enrolled as many Tricare beneficiaries as possible in automatic prescription drug delivery. The PBM allegedly refilled 90-day prescriptions on day 60, meaning that patients received 73% more doses than prescribed over a year. As a result, the company collected $6.3 billion in dispensing fees from 2009 to 2017, at least $1.8 billion of which was for excessive refills, the whistleblower alleged.

The False Claims Act allows whistleblowers to file a lawsuits on behalf of the federal government and to recover a portion of any damages awarded. The plaintiff initiated the lawsuit in 2019 and the court unsealed in last year.

Express Scripts and the plaintiff’s law firm, Constantine Cannon did not immediately respond to requests for comment.


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