World’s largest HIV/AIDS healthcare provider sends personal letter detailing how lack of Express Scripts oversight is ripping apart nation’s healthcare system
LOS ANGELES (April 24, 2023) – AIDS Healthcare Foundation (AHF), the world’s largest HIV/AIDS healthcare provider, sharply criticized healthcare behemoth Cigna today over its management of Express Scripts, the nation’s second-largest Pharmacy Benefit Manager (PBM), which Cigna acquired in a 2018 merger. AHF’s criticism comes on the heels of a so-called “transparency” campaign Cigna and Express Scripts recently launched.
In a letter to Cigna CEO David Cordani, AHF President Michael Weinstein details how Cigna, through its Express Scripts PBM, “…is ripping apart the healthcare system through its rapacious, self-serving, member-unfriendly practices…”
Issues concerning AHF and hundreds of independent and mom-and-pop pharmacies nationwide include the following:
- Express Scripts (ESI) actively drives pharmacies out of its networks through reimbursements that don’t even cover a pharmacy’s drug costs, let alone the costs associated with dispensing the drugs and consulting with patients. This predatory practice is contributing to the bankruptcy of independent pharmacies and to the creation of pharmacy deserts, leaving members stranded.
- ESI is hopelessly conflicted – preferring to drive pharmacy benefit to its own specialty mail-order pharmacy Accredo than broker honest deals with competing pharmacies. Members with chronic diseases like HIV suffer because when forced into mail order, they lose their tie with their trusted pharmacy care team member and are thrown into an anonymous service that often doesn’t understand the sensitivities around serving people with HIV.
- ESI operates secret offshore entities like Ascent Health Services, apparently to negotiate sweet deals with manufacturers that only profit ESI/Ascent.
- ESI creates so-called quality performance programs, which essentially are rigged “pay to play” schemes.
AHF also cautions that “Cigna has a responsibility to bring [ESI’s] greed into check,” concluding, “If you do not, federal and state lawmakers, regulators, the press, the public, and ultimately, members will do it for Cigna.”
A concise 3-minute PBM explainer video online here neatly distills the complex issue into easily understood language.