A trade group representing nearly 5,000 independent pharmacies has filed a lawsuit alleging that Prime Therapeutics entered into an anticompetitive agreement with Cigna’s Express Scripts to fix pharmacy reimbursement rates and fees.
The complaint was filed last week in federal court in Washington, D.C., by Protecting Access to Retail Pharmacy, which operates under the name Trust. The National Community Pharmacy Association formed this group three years ago to support pharmacies in investigations and potential litigation against pharmacy benefit managers.
Express Scripts provides certain services related to retail pharmacy networks and contracts with pharmaceutical manufacturers under a 2019 agreement with Prime Therapeutics.
The plaintiffs allege this agreement allowed Prime Therapeutics to match Express Scripts’ reimbursement rates and fees, resulting in lower payments and higher costs for participating pharmacies. They further allege the arrangement violates the Sherman Antitrust Act and constitutes a breach of contract. Trust asked the court for treble damages, attorneys’ fees, costs and other monetary relief.
“Express Scripts, like other large PBMs, uses its market power to force pharmacies to accept lower reimbursement rates and higher fees than the pharmacies otherwise would,” according to the lawsuit. “The greater the number of plan members that a PBM represents, the greater its market power. Pharmacies, including plaintiffs, must either bow to Express Scripts’ demands on reimbursement rates and fees or effectively lose access to many millions of plan members. Plaintiffs and other pharmacies have no realistic option other than to accept Express Scripts’ terms, because they cannot reasonably operate if they are cut off from such a large segment of potential customers.”
Prime Therapeutics denied the allegations in a statement to Fierce Healthcare.
“This misguided litigation would roll back those savings and have real cost implications for patients and payers,” a spokesperson said. “Prime Therapeutics has played an integral role in bringing down prescription drug costs, and we always strive to balance cost savings for patients with equitable reimbursement for pharmacies. By offering more network options for savings as part of our approach, we’ve driven lower costs at the pharmacy counter for tens of millions of Americans, while delivering billions of dollars in savings for the patients, health plans and other clients we serve.”
Last year, an arbitrator ruled against Prime Therapeutics in a similar lawsuit alleging price-fixing. The ruling awarded the AIDS Healthcare Foundation $10.3 million in treble damages. Prime Therapeutics operates as a privately held company with more than 7,000 employees. It serves approximately 27 million members through partnerships with various health plans, employers and government programs, including Medicare.