SaveOnSP and PrudentRx Investigation

Overview
Pharmacy Benefit Managers (“PBMs”) like Express Scripts and Caremark have partnered with secretive third party companies like SaveOnSP and PrudentRx to siphon off patient copay assistance meant to help patients afford their prescription drugs and to foist thousands of dollars in additional healthcare costs onto patients. Lockridge Grindal Nauen PLLP (“LGN”) is investigating the ways in which these programs violate federal law and increase healthcare costs for targeted patients.

Background

The Affordable Care Act (the “ACA”) provides safeguards against excess healthcare costs for patients in the U.S., including an upper limit on patients’ copay and coinsurance obligations and an maximum that a patient can be forced to pay out-of-pocket each year. Still, prescription drug costs threaten to undermine these protections: a majority of patients on employer-sponsored health plans report delaying filling prescriptions, rationing medications, or skipping prescribed therapy altogether due to cost; and three quarters of patients cannot afford prescriptions that cost $250 or more out of pocket.

To help ensure patients can access necessary and life-saving medications, manufacturers of drugs with high patient costs offer patient assistance programs. These programs cover patients’ out-of-pocket costs up to a set amount. These patient assistance programs, traditionally, have helped reduce the cost burdens of patients with complex and expensive medical conditions.

Recently, PBMs have partnered with companies like SaveOnSP and PrudentRx to evade the ACA’s protections and nullify the relief that patient assistance programs provide. As a result, targeted patients end up having to pay thousands of dollars in additional medical costs during the year that otherwise would have been paid by their insurer after they reached their maximum out-of-pocket limits.

Details of the Investigation

LGN is investigating potential claims against SaveOnSP, PrudentRx, and other companies that violate the ACA and force patients to incur excess healthcare costs. We are looking to speak with patients that have enrolled in SaveOnSP, PrudentRx, or similar programs about their experience with the program, and looking for patients that would like to help us put an end to these practices.

Contact
If you have been impacted by programs like SaveOnSP or PrudentRx and would like to get involved, please submit your information below or reach out to Brian Clark or Kristie LaSalle.