Regulators propose fines against pharmacy benefits managers

csimt In The News

By: Amy Beth Hanson

Prime Therapeutics has operated without a license since 2013, and two subsidiaries of Express Scripts were unlicensed while handling claims from 2013 to 2017, state Auditor and Insurance Commissioner Matt Rosendale said. The companies also have failed to fully comply with requests for copies of contracts and pricing data sought by lawmakers, he said.

“These companies need to understand that we are serious about consumer protection and that they will be held accountable for their actions,” Rosendale said in a statement Wednesday.

Prime applied for a license in April. But it has not provided the information sought by the state so the commissioner’s office declined to issue a license…

Both companies can ask for hearings on the licensure issue and proposed fines, which could total up to $30,000 for each violation of the Montana Insurance Code.

Prime Therapeutics is owned by Health Care Service Corporation, the parent company of Blue Cross and Blue Shield of Montana. It has handled nearly 6 million claims for Blue Cross in Montana since 2013, each of which could be considered a code violation, the commissioner’s office said. Express Scripts handled claims for the Montana Health CO-OP.

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