A little background on the case: In 2015, three compounding pharmacies brought a case against four largest PBMs—Express Scripts, CVS Health Corporation, OptumRx, Inc., and Prime Therapeutics, LLC—under the Employee Retirement Income Security Act (ERISA), alleging that PBMs systematically denied payment of compound drug claims without adhering to ERISA’s claims regulation. The judge denied pharmacies’ motion for a preliminary injunction and pharmacies appealed. The Court of Appeals (8th Circuit court) affirmed and held that the district court did not abuse its discretion in denying preliminary injunction.
Why this case is still relevant:
The case didn’t end with the 8th Cir. ruling. The pharmacies renewed its efforts and filed a second amended complaint alleging that PBMs jointly boycott compounding pharmacies and eliminate them from the market by ending insurance coverage for compounded prescription medications in violation of the Sherman Act and state antitrust laws in Texas (a different theory). The pharmacies also assert that PBMs’ conduct constitutes unfair competition under Texas and Missouri law and tortious interference with business relations under Texas common law.
PBMs filed a motion to dismiss. The court held for pharmacies and determined that they have sufficiently plead that defendants engaged in an antitrust conspiracy to boycott pharmacies and that defendants tortiously interfered with plaintiffs’ business relationships. Thus, pharmacies’ claims of antitrust violations and tortious interference are going forward. Stay tuned.
Prime Aid Pharmacy Corp. v. Express Scripts, Inc., No. 4:16-CV-1237 (CEJ), E.D. Mo., 2017 U.S. Dist. LEXIS 6692, 2017.