Credit: Allison Bell/Touchpoint Markets
A giant supermarket chain is suing a giant pharmacy benefit manager over how the PBM handles claims for brand-name drugs.
The supermarket chain, Albertsons, has accused Cigna's Express Scripts unit of routinely violating pharmacy contract network terms in 2023 by reclassifying claims for brand-name drugs as claims for generic drugs.
"Because Express Scripts flipped drugs from brand to generic classifications, long after the patient paid for them as brand drugs, Express Scripts reimbursed Albertsons Companies at a lower reimbursement rate than the rate for brand drugs," Albertson's said in a complaint filed in a state court in Delaware.
"Express Scripts has been unjustly enriched by failing to pay the $3,665,637 that Express Scripts has admitted is owed to Albertsons Companies as a result of an underpayment during the 2023 reconciliation," the company said.
Albertsons — the parent of Safey supermarkets as well as Albertson's stores — said, for example, that Express Scripts ended up coding claims for prescription drugs such as Clomid, which cost $39 for a standard amount, and Suboxone, which cost $603.46 for a standard amount, as generic drugs. The company redacted the actual reimbursement amounts in the version of the complaint available to BenefitsPRO.
Albertsons started the lawsuit in December 2025. It asked for permission to file the complaint under a confidentiality seal.
The National Community Pharmacist Association has posted a redacted version of the complaint on its website.
Albertsons is the second biggest supermarket chain in the United States, with 2,279 locations in 1,215 cities and 36 states, according to ScrapeHero.com.
Representatives for Albertsons and Cigna could not immediately be reached for comment.
What it means: The supermarkets where many employers' health plan participants fill their prescriptions are not happy with the PBMs.
If supermarkets sour on operating pharmacies, that could make the current "pharmacy desert" problem even worse.
But Kroger, the fourth-biggest supermarket chain, recently signed a new agreement with Express Scripts for its pharmacies.
The Kroger agreement could be a sign that many supermarkets still want to operate pharmacies.
The backdrop: Health insurers and the third-party administrators that run employers' self-insured health plans say they are facing a big surge in health claims.
Many have suggested that aggressive efforts by health care providers to improve the completeness and accuracy of claim "coding" could be partly to blame, by making patients look sicker and in more need of expensive care than they would have looked based on the old coding strategies.
The clash between Albertsons and Express Scripts may be part of a pharmacy-vs-PBM version of the "claim editing" and downcoding fights occurring over hospitals' and physicians' bills.
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