Express Scripts sued by 4 independent pharmacies, alleging price fixing
The lawsuit, which alleges that the pharmacy benefit manager colluded with Prime Therapeutics to charge higher fees, comes weeks after an independent pharmacy association launched an investigation into PBM fees.
Four independent pharmacies in three states filed a class-action lawsuit last week alleging Express Scripts of colluding with Prime Therapeutics to charge higher fees and reimburse pharmacies at lower rates. The complaint, which claims violation of the Sherman Act, argues “that a three-year collaboration agreement announced in 2019 between Express Scripts and Prime Therapeutics was in fact a pretext for fixing reimbursement rates and fees, with no benefit for customers,” according to Reuters.
The pharmacies — two in Wisconsin, one in Minnesota, and one in New Jersey — claim “the Agreement does not, and is not intended to, achieve any efficiencies or economies of scale or procompetitive effects in the relevant markets, and the assertion of any such efficiencies or procompetitive effects by either Prime or [Express Scripts] is pretextual,” according to the lawsuit, which was filed in Milwaukee federal court. “The Agreement is simply a naked restraint on price competition with regard to Reimbursement Rates and Transaction Fees.”
Cigna-owned Express Scripts is one of the largest pharmacy benefit managers in the United States and in April announced efforts to expand health care in rural communities through partnerships with independent pharmacies across the country with “increased reimbursement opportunities.”
The company called the lawsuit “baseless” in a statement, adding that it is “committed to reimbursing network pharmacies fairly.” Prime Therapeutics was not named as a defendant and reportedly has not issued a statement regarding the case.
Related: ‘It’s payback time!’ Community pharmacies unite to fight PBMs over ‘junk’ fees
This is the latest example of independent pharmacies standing up to PBMs over fees. Earlier this month, the National Community Pharmacists Association — which represents more than 19,400 pharmacies that employ nearly 240,000 individuals — launched Trust LLC to investigate the use of direct and indirect remuneration (DIR) fees on behalf of community pharmacies.
At that time, association CEO B. Douglas Hoey claimed DIR fees have risen by more than 107,400% in recent years — bringing some community pharmacies to the brink of insolvency.