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Express Scripts, Mass. settle over millions in comp overcharges


Pharmacy benefits manager Express Scripts Inc. has agreed to pay $3.2 million after allegedly failing to follow prescription pricing procedures that prevent overcharges in the workers compensation insurance system, Massachusetts Attorney General Maura Healey announced Monday.

Court documents say that in some circumstances Express Scripts failed to apply various regulatory benchmarks — such as the Federal Upper Limit for Medicare and the Massachusetts Maximum Allowable Cost — to its pricing determinations, according to a statement from the attorney general.

The terms of the settlement require Express Scripts to implement procedures to prevent overcharges in the workers compensation insurance system and ensures that Express Scripts will cooperate with monitoring of the company’s future regulatory compliance.  

This case is part of an ongoing review by the attorney general’s office into prescription pricing procedures in the workers compensation system. The office says it has so far reached settlements with several pharmacy benefits managers over comp drug pricing violations totaling approximately $16 million.

Officials at Express Scripts did not respond to a request for comment.