Chronic sufferers reliant on prescription drugs are trapped in an illegal, insidious, and incompetent monopoly, complaint alleges.
CHICAGO — Today, attorneys at the law firm of Loevy + Loevy filed a lawsuit in federal court accusing online “specialty” pharmacy Accredo—and an entire distribution chain leading up to Accredo’s parent company, The Cigna Group— of monopolistic business practices that prey on the chronically ill.
The lawsuit is brought on behalf of nine individual plaintiffs who are facing endless problems getting the medicines their doctors prescribed. The suit seeks certification of a class of similarly situated Accredo customers —potentially tens of millions of patients—who are similarly endangered by what the suit claims is a conglomerate that profits from persistently abusing its captive customers.
Few Americans realize that a maze of middlemen are involved in filling prescriptions, including insurers, “pharmacy-benefit managers” (PBMs), and specialty pharmacies, which quietly control how much drugs cost and who gets paid. The three largest PBMs now control nearly 80 percent of all U.S. prescriptions, with Express Scripts—the PBM owned by The Cigna Group and its subsidiary Evernorth—controlling the largest share of the market. Leveraging their control, Evernorth and Express Scripts require patients to exclusively use their online pharmacy Accredo to get whatever medicines they choose to classify as “specialty drugs.”
Patients have no choice but to deal with Accredo, and Accredo takes advantage of them by offering substandard care. “Trapping patients within this incestuous system of nested companies violates state and federal antitrust laws and is unfair and dangerous,” says attorney Michael Kanovitz. “With a stranglehold on nearly a third of all U.S. prescriptions, the companies can get away with shockingly poor healthcare services, profiting off of the helplessness they impose.”
Plaintiff Heather Lisser of Wisconsin, for example, is a transplant-recipient who requires a strict regimen of drugs to prevent her own immune system from attacking and possibly rejecting her transplanted organ. Nevertheless, Heather has experienced persistent delays and difficulties in obtaining authorizations for refills through Accredo. On dozens of occasions, she has been forced to spend multiple hours on the phone with Accredo’s customer support after being informed that there were problems refilling her medication—often being bounced from representative to representative, with each one reading the same script, asking the same questions, and often providing a completely different explanation of the problem than the previous excuse. On several occasions, she has been forced to drive more than an hour away to obtain an emergency bridge refill and avoid potentially fatal complications.
According to the complaint, this experience of unjustifiably long and unexpected delays—and completely contradictory explanations for them—is not just common but standard practice at Accredo. Plaintiff Jennifer Belllucci of Texas, for example, is the wife of a military veteran, and insured through the Department of Defense’s TRICARE West, which uses Express Scripts as its PBM. Jennifer’s four children all suffer from juvenile idiopathic arthritis, which causes intense joint pain and inflammation.
Jennifer is reliant on Accredo to fill the prescriptions that keep her children’s pain at bay, but Jennifer has experienced weeks of delays spent navigating Accredo’s customer support system. On at least one occasion she had a prescription canceled without explanation or warning, only discovering the problem when the medicine for her child failed to arrive. Unwilling to let her child miss another dose of pain-relieving medication, she drove seven hours across the State of Texas to pick up a free sample of the medication at a children’s hospital in Houston. Jennifer has experienced similar problems with all of her children’s medications, including Accredo refusing to fill one doctor-prescribed medication and instead suggesting a different drug that was not even FDA-approved to treat juvenile idiopathic arthritis.
“Our clients have been consistently inconvenienced, insulted, and endangered by Accredo, and we know this is not an isolated problem because we’ve heard from hundreds of others with substantially identical stories,” says attorney Aaron Tucek. “The complaint we filed today alleges that these experiences are not isolated failures in an otherwise functioning system, but the foreseeable result of a business plan that puts profit over meeting patients’ needs. If we multiply our clients’ experiences across the tens of millions of prescriptions this monopoly controls, we have a nationwide healthcare crisis that is being caused by The Cigna Group and its subsidiaries.”
The complaint filed today names as defendants Accredo Health Group, Express Scripts, Evernorth Health, Inc., and The Cigna Group. It charges them with eleven counts of violating state and federal laws, including multiple violations of the Sherman Antitrust Act. It asks for injunctive relief from the illegal practices, and for a jury to award actual and punitive monetary damages.
In addition to Michael Kanovitz and Aaron Tucek, plaintiffs are represented by Jon Loevy, Scott Rauscher, Ross Kimbarovsky, Isaac Green, and Alexandra Wolfson of Loevy + Loevy.
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Read the complaint in this case here.