Credit: Paweł Michałowski/Adobe Stock
Patients and patients' caregivers are suing Accredo Health Group — a Cigna specialty pharmacy business — and other Cigna businesses over allegations that they have been using their market power to drive up patients' share of specialty drug costs and skimp on service.
Specialty drugs are very expensive drugs that help patients cope with serious, complicated health problems.
The plaintiffs in the new suit, Kimberly Wolf et al. v. Accredo Health Group, Express Scripts, Evernorth Health and the Cigna Group, have accused Accredo of forcing patients to handle prescription concerns by talking to poorly trained customer service representatives, requiring the patients' doctors to use the same customer support telephone lines that patients use, and forcing doctors to engage in long conversations to resolve prescription processing issues, according to a complaint filed earlier this month in the U.S. District Court for the Northern District of Illinois.
Accredo often fails to deliver important drugs before the patients are supposed to take the drugs, the plaintiffs say.
One of the original named plaintiffs, Heather Lisser, says that, because Accredo frequently misses delivery deadlines for her prescriptions, she often has to go to the hospital emergency room to get a drug she needs to keep her body from rejecting an organ transplant.
Some of the named plaintiffs listed in the complaint connected with Accredo through employer-sponsored health plans, according to the complaint. The plaintiffs do not say in the complaint whether any of the employer plans are fully insured or self-funded, and the plaintiffs do not say whether they believe the plans were governed by the Employee Retirement Income Security Act.
The plaintiffs are seeking court permission to represent a class that would include all patients who were required by a health plan to use Accredo and who either paid for a prescription filled by Accredo or who tried to fill a prescription through Accredo and failed to receive the prescription by the dosing date recommended by the prescribing physician.
At press time, attorneys for Accredo and Cigna had not yet filed a response to the complaint in court.
Cigna said in a statement that Accredo's "pharmacists, nurses, social workers, dietitians, patient care advocates, and more provide exceptional care to people living with chronic and complex conditions."
"We will vigorously defend ourselves against these unfounded allegations," the company said. "To be clear: Clients of Express Scripts, our pharmacy benefits services company, have full control of their benefit design and are never required to use Accredo as their exclusive in-network specialty pharmacy."
What it means: The Accredo suit could be a sign that plaintiffs' attorneys are starting to turn their attention to the specialty drug distribution system.
For employers, that could help address some price and service concerns, but it could also lead to unwanted, litigation-driven changes in specialty drug provider options.
Accredo: Accredo is part of a Cigna specialty pharmacy business that generated $65 billion in specialty prescription dispensing revenue in 2024 and accounted for 25% of U.S. specialty prescription dispensing revenue that year, according to data compiled by the Drug Channels Institute.
Accredo ranked second after CVS Health's CVS Specialty business. CVS Health also owns Aetna.
UnitedHealth Group's Optum Specialty Pharmacy ranked third.
Walgreens, which ranked fourth, was the biggest specialty pharmacy not affiliated with a big health insurer.
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.