Cease-and-desist orders issued to Express Scripts, Office of Group Benefits

Published 2:35 pm Monday, January 23, 2023

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

Express Scripts Administrators is a third-party administrator operating as a pharmacy benefits manager for the Office of Group Benefits. 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 Jan. 1-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.

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“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.

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