Independent pharmacies sue Express Scripts, allege price-fixing

Several independent pharmacies have filed suit against pharmacy benefit management giant Express Scripts, alleging that the company colluded with Prime Therapeutics to fix reimbursement rates.

The four pharmacies comprise two in Wisconsin, one in Minnesota and one in New Jersey. 

In late 2019, Express Scripts and Prime announced that they would enter into a three-year collaboration in which the former would provide key services around retail pharmacy networks and contracting with drugmakers. The lawsuit calls this arrangement an "anticompetitive and unlawful" deal that enabled the two to fix prices.

The lawsuit alleges that the agreement led both to charge retail pharmacies a higher transaction fee rate while reimbursing at a lower rate, both of which had been established by Express Scripts prior to the arrangement.

Despite the collusion accusations, Prime Therapeutics is not named as a defendant in the suit.

The partnership, according to the lawsuit, did not bring any new efficiencies or programs to the table for either Express Scripts or Prime but instead "merely serves as a price-fixing mechanism."

Through the arrangement, Prime was able to take advantage of Express Scripts' size to impose these high fees and lower reimbursement rates, according to the suit.

"The horizontal Agreement between ESI and Prime is a naked restraint of trade," the lawsuit reads. "ESI and Prime have not combined or integrated any meaningful assets or business functions."

In a statement to Fierce Healthcare, an Express Scripts spokesperson called the lawsuit "baseless."

"We are committed to reimbursing network pharmacies fairly and will vigorously defend ourselves against the baseless allegations in this complaint," the spokesperson said.

Pharmacy benefit managers have been under the microscope of late as policymakers examine the role that they play in the pharmaceutical supply chain. A bevy of regulatory changes have been proposed in Congress, and the Federal Trade Commission is taking a deep dive into the business practices of major companies including both Express Scripts and Prime.