Ann Lewandowski is aware of all about pharmacy profit managers, or PBMs, the businesses that form the U.S. drug market. Her job, as a coverage advocate at drugmaker Johnson & Johnson, was to inform affected person and doctor teams in regards to the PBMs’ position in excessive drug costs.
Armed with that information, Lewandowski filed a doubtlessly groundbreaking lawsuit in February. Relatively than concentrating on the PBMs, nonetheless, she went after a giant firm that makes use of one — her personal employer, Johnson & Johnson.
Lewandowski expenses in her lawsuit that by contracting with the PBM Categorical Scripts, which is a part of the insurance coverage big Cigna, Johnson & Johnson — which fired her in April — failed in its responsibility to make sure affordable drug costs for its greater than 50,000 U.S. workers.
By selecting an Categorical Scripts plan, she charged, J&J value workers “millions of dollars in the form of higher payments for prescription drugs, higher premiums, higher deductibles, higher coinsurance, higher copays, and lower wages or limited wage growth.”
Lewandowski, 40, from outdoors Madison, Wisconsin, depends on an costly a number of sclerosis drug. She introduced the lawsuit, she stated, as a result of she “had trouble aligning the policy positions” she reported on as a J&J worker “with the actions I experienced as a health plan user.”
Lately, the opaque enterprise practices of PBMs have drawn fireplace. The Federal Commerce Fee is conducting a prolonged investigation of the three greatest corporations and sued them in September, accusing the corporations of driving up insulin costs. Bipartisan payments in Congress would rein them in. And companies similar to Mark Cuban’s Price Plus Medicine and smaller, “transparent PBMs” have tried to wean pharmaceutical corporations and well being plans from their reliance on the massive PBMs.
However Lewandowski’s lawsuit goes to a delicate spot that had been missed till not too long ago: language within the 2021 appropriations invoice that revised the 1974 Worker Retirement Revenue Safety Act, generally known as ERISA. The unique regulation targeted on stopping fraudulent retirement plans.
Her lawsuit is predicated on congressional language specifying that the regulation’s requirement of prudent administration covers well being in addition to retirement advantages. By offering staff with a well being plan, employers aren’t “doing you a favor. They are holding your money and investing it in your health,” stated Barak Richman, a George Washington College well being regulation professor.
In July, the same lawsuit was filed in opposition to Wells Fargo, and extra fits are within the works.
