FOR IMMEDIATE RELEASE

January 23, 2023

Cease-and-Desist Orders Issued to Express Scripts and Office of Group Benefits for Failure to Pay Rx Claims in a Timely Manner

Investigators at the Louisiana Department of Insurance (LDI) issued a cease-and-desist order on December 29, 2022, to Express Scripts Administrators, LLC, and, consequently, the Office of Group Benefits, for violating state law by failing to pay over 1.3 million electronically adjudicated insurance claims to eligible pharmacists in a timely manner.

Express Scripts Administrators (ESA) is a third-party administrator operating as a pharmacy benefits manager for the Office of Group Benefits (OGB). OGB provides health and life insurance benefits to qualified state employees and retirees of participating agencies and their eligible dependents. ESA’s contract with OGB provides for full indemnification of any losses incurred by OGB that are caused by ESA’s obligations under that contract.

The LDI launched a market conduct investigation of ESA on April 5, 2022, after receiving multiple complaints from the Louisiana Independent Pharmacy Association regarding ESA’s claims handling. The investigation revealed that between January 1, 2022, and July 12, 2022, ESA failed to pay 1,310,507 electronically adjudicated claims on behalf of OGB within 15 days as required by Louisiana law.

“Louisiana health care providers are deserving of full compliance with Louisiana law relative to payments they are entitled to receive from insurers and the third-party administrators associated with them,” said Insurance Commissioner Jim Donelon.

A copy of the cease-and-desist orders is available here.

ESA and OGB have 30 days from the time of service to request an administrative appeal before the above actions become final.

About the Louisiana Department of Insurance: The Louisiana Department of Insurance works to improve competition in the state’s insurance market while assisting individuals and businesses with the information and resources they need to be informed consumers of insurance. As a regulator, the LDI enforces the laws that provide a fair and stable marketplace and makes certain that insurers comply with the laws in place to protect policyholders. You can contact the LDI by calling 1-800-259-5300 or visiting www.ldi.la.gov.