Cigna Prescription Drug Fee Lawsuit Alleges Overcharging Scheme

A woman has filed a class action Cigna prescription drug fee lawsuit over allegations the health insurance company overcharged for medications.

Cigna is accused of collecting “clawback fees,” which are amounts collected by the insurance company when the insurance company requires pharmacies to charge a co-pay for a drug that could be purchased for less money directly from the pharmacy without using insurance.

The difference between the co-pay amount and lesser cost of the drug is “clawed back” to the insurance company, which reaps the profit.

For example, a patient paid a $20 co-pay to a pharmacy to purchase a prescription drug, which was 1,042 percent more than the fee paid by Cigna to the pharmacy. Cigna contracted to pay the pharmacy $1.75 for the prescription, but told the pharmacy to collect the $20 “co-pay” from the insured. Cigna then pocketed the $18.25 difference.

According to the Cigna prescription drug fee lawsuit, “The secret payment of the ‘spread’ to the Defendants and/or their agents is known as a ‘clawback.’”

When an insured person pays a co-pay, the co-pay should never be more than the amount paid the insurance company paid the pharmacy for that prescription.

Oftentimes, the pharmacy is contractually banned from informing customers that there are cheaper alternatives to paying the co-pays that enable clawbacks.

In some instances, pharmacists are unaware of the clawbacks until monthly reconciliations show evidence of these clawbacks after the drugs have already been dispensed to customers who have paid the inflated co-pay prices.

Cigna Prescription Drug Fee Lawsuit Alleges Fraudulent Activity

According to the Cigna prescription drug fee lawsuit, Cigna has secretly taken clawbacks from customers, an action opposed in its own policies.

In one quote taken from Cigna policies, the line states “In no event will the… Coinsurance for the Prescription Drug or Related Supply exceed the amount paid by the plan to the Pharmacy, or the Pharmacy’s Usual and Customary (U&C) charge.”

The U&C charge is defined as the pharmacy’s retail cash price, “less all applicable customer discounts that Pharmacy usually applies to its customers regardless of the customer’s payment source.”

Many patients don’t realize their insurance companies are obtaining clawbacks because the patients are unaware of the drug’s cost without insurance. Most patients pay the co-pay, unaware it could be more than the cost of the medication without insurance.

By definition, a co-pay should be a fraction of the true cost of the drug, not a charge that exceeds the true cost of the medication.

More than 80 million Americans might be victims of such prescription drug fraud by insurance companies overcharging for medications. The Cigna prescription drug fee lawsuit is only the tip of the iceberg.

If you have been overcharged for a prescription drug, denied coverage or overcharged for a service, you could be eligible for compensation through a legal claim.

The Cigna Prescription Drug Fee Lawsuit is Case No. 16-cv-1702 in the U.S. District Court District of Connecticut.