Express Scripts Lawsuit Filed by Three Compounding Pharmacies

According to the plaintiffs in the suit against Express Scripts: Grasso Enterprises, LLC, d/b/a Annie’s Apothecary, NERxD, LLC, d/b/a Cypress Compounding Pharmacy, and Wiley’s Pharmacy and Compounding Services, Inc., filed by their attorneys Quadrino Law Group, P.C. and The Simon Law Firm, P.C., claim “Express Scripts (“ESI”), has recently embarked upon a scheme to deny all claims under health plans seeking payment for “compound” pharmaceutical medications”. According to the complaint, Compounded medicines are customized pharmaceuticals made according to specific prescriptions, written by physicians, where no appropriate alternatives are mass-produced or commercially available. Health plan claims for these compounded medicines have, up to last year, been routinely paid by Express Scripts directly to in network compound pharmacies.

You can read the full suit here:

Adjudication of the lawsuit against Express Scripts will take some time, in the meantime, thousands of claims go denied and this thousands of patients may not get the care deemed necessary by their primary care physician. Currently, many compounding pharmacies are taking steps to help patients in order to maintain relationships with them and their physicians, but some of these steps actually cost the compounding pharmacy money.

Some national manufacturers are seeing the problem and developing substitutions, but many of these manufacturers are limiting who can utilize these solutions.  MedX Sales is on the other hand working with a national manufacturer who will allow our clients access to these solutions.  We have 2 solutions that with their AWP provide a good ancillary program to Compounding Pharmacies while providing solutions that are better than options available to most Compounding Pharmacies today.

To learn more about the options Compounding Pharmacies have with MedX Sales:

Compounding Pharmacy Claim Rejection Solutions