The Alabama Department of Insurance's new PBM Compliance Division issued its first enforcement actions since implementing Act 2025-136, enacted last year as SB 252. The administrative action called out Express Scripts (ESI) on three counts.
First, ESI charged pharmacies a wide array of illegal fees. Second, ESI did not reimburse pharmacies serving patients in the commercial market at the Medicaid reimbursement rate, per the law. Third, when the department sought information from ESI to engage complaints from pharmacies, ESI was consistently unresponsive.
The department has asked the Office of the Insurance Commissioner (OIC) to schedule a hearing. If found in violation of the law, ESI's license could be suspended until they show willingness to comply with the regulatory regimen. The OIC can also issue civil penalties or seek other forms of relief. The ESI complaint can be found on the department's new PBM Actions webpage.
