Some Facts About CareZone

Jun 19, 2018

Our network pharmacies are expected to deliver quality care, affordable access, and operate legally. Good news is that most every one of the 70,000 pharmacies we work with shares those traits. Then there is CareZone.

At Express Scripts, we work with employers, health plans, government agencies, unions and other plan sponsors to build and sustain networks of pharmacies.  For nationwide access to retail pharmacies, PBMs like Express Scripts create retail pharmacy networks by negotiating provider agreements with pharmacies that agree to fill prescriptions for our members at retail, storefront locations.  In exchange, retail network pharmacies get a number of benefits, including access to Express Scripts’ members as customers.

Laws, rules and regulations govern how pharmacies operate and how we, as a pharmacy benefit manager, work with those pharmacies. It is our duty to regularly review the practices of pharmacies in our network to ensure compliance with such laws, rules and regulations.

We work with more than 70,000 pharmacies in America to make sure our members have affordable and convenient access to medicine, as well as quality pharmacy care.  Most pharmacies comply with the rules. However, when a pharmacy breaks the law, misrepresents itself, or otherwise violates the agreement we have, we have to take action and remove it from the network.

Violating Retail Provider Agreement, State Law

In the case of CareZone, that is exactly what we are doing. During a recent review, we found two CareZone Pharmacy locations were operating in direct violation of the retail provider requirement in their agreements, had failed to comply with a number of other obligations under their agreements, and that many prescriptions were being mailed to states where the dispensing pharmacy was not licensed, which is a violation of state law. The integrity and reputation of Express Scripts’ retail pharmacy networks is critical to Express Scripts’ business, client relationships, and most importantly, patient safety. Because CareZone is violating state pharmacy laws and is unwilling to comply with its contract, we are removing CareZone from our network.

CareZone responded by threatening to contact Express Scripts’ members that may have filled a prescription at CareZone, as well as various state and federal government agencies, about this dispute in order to falsely accuse Express Scripts of bad faith in connection with its decision to terminate CareZone from our networks.

CareZone indicated that it would only refrain from taking these actions if Express Scripts caved to its threats and reinstated CareZone into Express Scripts’ retail networks immediately. Express Scripts refused to give in to these extortionate demands.

Convenient Pharmacy Access

Our focus remains clear: help people get the medicine they need in the most safe, effective, and convenient way possible.

The good news for the few hundred Express Scripts members that use CareZone is that they have many pharmacy options available, including access to 70,000 retail and community pharmacies nationwide.

We are available to help any affected member easily transition to another nearby pharmacy that will provide quality, affordable access to medicine, and do so lawfully.

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