An Arkansas pharmacy has filed a potential class action lawsuit against Express Scripts claiming its reimbursement system is unfair.
Lackie Drug Store Inc. filed the federal lawsuit against Express Scripts Inc. and affiliates ESI Mail Order Processing Inc., ESI Mail Pharmacy Service Inc. and Express Scripts Pharmacy Inc.
According to the complaint, Express Scripts, which is one of the world's largest Pharmacy Benefits Managers (PBMs), sets its Maximum Allowable Cost (MAC) – an unpublished maximum reimbursement value – below various price indexes including the plan price or network price, the usual and customary price, and the pharmacy’s invoice cost in acquiring medication.
Lackie Drug Store says this low MAC set by Express Scripts affects its reimbursement rates when it fills prescriptions under the plan.