Cigna PBM faces $10.9M lawsuit for ‘flipping’ drug classes – Becker’s Payer Issues

Grocery chain Albertsons is suing the Cigna-owned pharmacy profit supervisor Categorical Scripts for at the least $10.9 million for alleged prescription underpayments, in response to a Jan. 7 grievance shared by the Nationwide Group Pharmacists Affiliation.

The lawsuit filed in Delaware’s Superior Court docket mentioned, in 2023, Categorical Scripts initially labeled prescriptions as brand-name medicine throughout a sale, however the PBM finally allegedly reclassified some as generics — a course of often known as “flipping” — throughout an annual reconciliation. At that time, the medicine had been distributed. Because of this, Albertsons pharmacies anticipated larger reimbursement charges.

Albertsons particularly claimed breaches of contract and the implied covenant of excellent religion and truthful dealing, in addition to unjust enrichment. After a sequence of makes an attempt to resolve the matter, the chain is requesting that Categorical Scripts pay at the least $7.3 million in damages and $3.6 million the PBM has reportedly already acknowledged.

Categorical Scripts denies these allegations.

“We’re dedicated to reimbursing community pharmacies pretty and can vigorously defend ourselves in opposition to the baseless allegations on this grievance,” an Categorical Scripts spokesperson informed Becker’s Jan. 14.