The big pharmacy benefits manager struck a deal with 28 states over charges that consumers were misled when docs were encouraged to cholesterol drugs under the guise of controlling costs. The agreement resolving a four-year investigation and follows a similar $38.5 million multistate settlement in February with Caremark, and settlement with Medco Health Solutions three years ago.

“Today’s settlement completes our effort to clean up the PBM industry,” Vermont’s Attorney General Bill Sorrell says in a statement. “Now that all three of the nation’s largest PBMs are under orders from our office and the court to reform their practices, we expect that the rest of the industry will take notice and follow the requirements we have established.”

Through the agreements, the states “have changed how these companies treat patients and doctors when they ask to change their prescription medications,” Martha Coakley, attorney general in Massachusetts, says in a statement. “Those requests now include full information on costs savings and the reasons for the proposed switch.”

Express Scripts will pay $9.3 million of the settlement total to the states and Washington DC, while another $200,000 will provide no more than $25 apiece to individual patients to reimburse them for physician visits and tests linked to switches between rival brands of cholesterol meds.

The PBM was deceptive by telling docs that patients and their health plans would save money from a switch to a different drug brand to treat the same condition. “Doctors, however, were not adequately informed of the effect this switch would have on costs to patients and health plans,” says Missouri attorney general Jay Nixon, in a statement.

In addition to the payments, Express Scripts is required under the settlement to make “clear and conspicuous disclosures” about its switching practices, according to Coakley. The PBM insists it will only have to make “only minor adjustments” in its practices to comply. In agreeing to the settlement, Express Scripts didn’t admit any of the allegations. (Here’s the statement).