Optum embroiled in Anthem-Express Scripts legal spat

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On Tuesday, the U.S. District Court for the Southern District of New York will hold a hearing on Express Scripts’ motion to compel Optum to turn over documents related to a drug pricing proposal it prepared for Anthem.

UnitedHealth subsidiary OptumRx is now caught up in the court battle between Anthem and Express Scripts.

On Tuesday, the U.S. District Court for the Southern District of New York will hold a hearing on Express Scripts’ motion (PDF) to compel Optum to turn over documents related to a drug pricing proposal it prepared for Anthem. The insurer requested the proposal after it sued Express Scripts back in 2016, seeking $14.8 billion in damages from what it argued was the pharmacy benefits manager’s failure to provide “competitive benchmark pricing” on prescription drugs.

Express Scripts said it is entitled to both documents and testimony concerning the proposal Optum prepared for Anthem, arguing that they are “critically relevant” to the case and that Optum knew full well they would be used in the litigation. From Express Scripts’ point of view, Optum prepared the proposal in order to “harm a competitor” and ingratiate itself with Anthem, which was a potential client.

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Optum, though, argued that it already provided all the relevant materials to Anthem pertaining to the case, and should not have to reveal proprietary information about the processes, procedures and analysis it used to general the proposal.

“To justify its efforts to sift through OptumRx’s confidential commercial information, [Express Scripts] has concocted a conspiracy theory entirely devoid of merit,” the UnitedHealth subsidiary said.

However, it may not be so far-fetched for Express Scripts to claim that Optum drew up the proposal for Anthem in an attempt to win its business. Since its dispute with Express Scripts arose, Anthem made it clear that it was weighing alternate PBM arrangements. Ultimately, the insurer announced in October that it would partner with CVS Caremark to create an in-house PBM.

Before Anthem and CVS announced their new partnership, CVS also provided the insurer with a pricing proposal, Optum noted in the court filing. It does not appear as though Express Scripts has attempted to compel CVS to turn over any documents related to that proposal.

This latest development in the Anthem-Express Scripts case offers evidence of how intense the competition for major clients has gotten among the country’s three largest PBMs—which are facing increased scrutiny from payers and policymakers alike.

Adding another wrinkle to the saga, CVS is also reportedly in talks to acquire Aetna. Such a deal would not only help CVS fend off the competitive threat of Amazon’s possible entry into the drug distribution business, but would also make it a stronger competitor to UnitedHealth and Optum—which have an integrated PBM model that is the envy of the industry.