Pharmacy Benefits Manager To Pay $275,000 for Allegedly Failing To Follow Pricing Procedures on Workers Compensation Prescriptions

Boston,MA (WorkersCompensation.com) -  Attorney General Maura Healey announced today that a pharmacy benefits manager, Health E Systems, LLC, has agreed to pay $275,000 for allegedly failing to follow prescription pricing procedures that are designed to keep costs down and prevent overcharges in the workers’ compensation insurance system.  

The pricing procedures, required by Massachusetts regulations, ensure that prescription costs will be reviewed against certain regulatory benchmarks. According to the assurance of discontinuance, filed this week in Suffolk Superior Court, Health E Systems allegedly failed to follow those procedures when applying prices for certain injured worker prescriptions at various retail outlets, including some prescriptions filled by injured workers at Boston CVS, Walgreen’s and RiteAid locations. 

“Our workers’ compensation insurance system is designed to ensure drug pricing is handled fairly and transparently, and costs are kept down for our injured workers,” said AG Healey. “Our office will continue to ensure that pharmacy benefits managers follow our state’s required procedures and do not drive-up costs in our workers’ compensation system going forward.” 

Under Massachusetts’ Workers’ Compensation system, when employees are hurt on the job, they are entitled to lost wages, compensation for injuries, and payments for certain injury-related expenses. The system sets limits for the cost of prescriptions for injured workers and requires companies to validate prices against certain regulatory benchmarks before processing their charges. 

This case is part of an ongoing review by the Attorney General’s Office into prescription pricing procedures in the workers’ compensation system. In addition to today’s assurance of discontinuance with Health E Systems, AG Healey has now reached settlements with Walmart, Express Scripts, Optum Rx, Walgreens, Stop & Shop, and United Pharmacy workers’ compensation pricing procedure violations totaling over $16 million.  

This case was handled by staff from Attorney General Healey’s Insurance and Financial Services Division, including Glenn Kaplan, Burt Feinberg, and Gia Kim.   

Share This Article: