A group representing thousands of pharmacies has filed an antitrust suit against Prime Therapeutics, alleging that the company colluded with rival Express Scripts to fix prices.
The lawsuit was filed July 2 in Washington federal court by Protecting Access to Retail Pharmacy, LLC, an organization that operates as TRUST, LLC. The group was formed in 2023 by the National Community Pharmacy Association to support pharmacies in investigations and potential litigation to recover controversial direct and indirect remuneration, or DIR, fees from pharmacy benefit managers.
Their complaint stems from a 2019 agreement between Express Scripts and Prime, under which Express Scripts would provide certain services related to retail pharmacy networks and contracts with pharmaceutical manufacturers. A group of independent pharmacies sued Express Scripts in 2023 over the agreement.
The relationship allows the two to collude to fix drug prices, as well as draw in greater revenue from pharmacies, the plaintiffs alleged in the complaint. TRUST, LLC said in the lawsuit that the case represents close to 5,000 pharmacies.
The pharmacies said that Express Scripts has lower reimbursement rates and imposes higher fees than Prime had established, but under the agreement, Prime adjusted its own rates to match Express Scripts' rates. As such, the PBM earned more revenue from pharmacies, and Express Scripts earned a cut themselves.
The two together also control a significant market share in the pharmacy benefits space, making it harder for pharmacies to fight back, according to the lawsuit.
"Express Scripts, due to the large number of covered lives it represents, enjoys substantial market power in setting Reimbursement Rates and Fees," according to the lawsuit. "The Agreements allow Prime to effectively rent Express Scripts’ substantial market power to impose lower Reimbursement Rates and higher Fees on independent pharmacies, including Plaintiffs, than the pharmacies would otherwise accept."
The pharmacies also argue that the partnership does not generate sufficient efficiencies to justify changes to fees or reimbursement, and that they are not conducting joint commercial activity under the agreement.
The plaintiffs are asking the courts to award damages and costs related to the alleged antitrust violations, as well as damages stemming from Prime's breach of contract, according to the complaint.
Despite the allegations of collusion, Express Scripts is not named as a defendant in the lawsuit. A spokesperson for Prime Therapeutics said in a statement to Fierce Healthcare that "this misguided litigation would roll back those savings and have real cost implications for patients and payers."
"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," the spokesperson said. "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."