Express Scripts Wins Dismissal of Nonprofit Pharmacy’s Antitrust Claims

U.S. District Judge Maria A. Lanahan dismissed the foundation’s antitrust claims against Express Scripts and its Accredo Health Group subsidiary, according to Courthouse News Service. The April 22, 2025, ruling found that the claims were barred under principles preventing parties from dividing disputes arising from the same underlying transaction across multiple lawsuits.

The decision is a victory for Express Scripts, a major pharmacy benefit manager, in a case that challenged its contracting practices and its role in the market for specialty medications in Louisiana.

The AIDS Healthcare Foundation, or AHF, operates a nonprofit pharmacy serving patients including people receiving treatment for HIV/AIDS and hepatitis C. It sued Express Scripts and Accredo in Missouri federal court in 2024, alleging that Express Scripts used its position as a pharmacy benefit manager to favor Accredo and undermine competition among specialty pharmacies in Louisiana, according to Courthouse News.

Lanahan did not resolve the broader antitrust allegations on their merits. Instead, the court determined that AHF had an opportunity to raise the claims during an earlier case against Express Scripts that was dismissed in February 2023 after the foundation failed to state a plausible claim for relief, Courthouse News reported.

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Because the earlier judgment was issued by a federal court in Missouri exercising diversity jurisdiction, Lanahan applied Missouri law in determining the judgment’s preclusive effect, according to the publication. Under Missouri’s prohibition against claim splitting, litigants generally cannot bring a second action based on the same transaction or circumstances after litigating an earlier case.

The judge found substantial overlap between the two disputes. Both centered on a 2017 Pharmacy Provider Agreement between AHF and Express Scripts and allegations that the pharmacy benefit manager used its bargaining leverage to impose unfavorable contractual conditions, including reimbursement terms and performance incentives, Courthouse News reported. Both cases also sought damages and an injunction preventing enforcement of provisions in that agreement.

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AHF argued that its newer lawsuit rested on different operative facts, included developments it learned about later and named Accredo, which wasn’t a defendant in the earlier litigation. The foundation contended that those differences allowed the antitrust case to proceed, according to Courthouse News.

Lanahan rejected that distinction, finding that the central theory in both cases was essentially the same: that Express Scripts wielded its market power to impose contractual terms that resulted in lower reimbursement payments to AHF. The court also pointed to AHF’s own allegation that Express Scripts sharply reduced its reimbursement payments around January 2021, undermining the foundation’s contention that it lacked a basis for the claims until 2024, Courthouse News reported.

The ruling comes amid broader scrutiny of pharmacy benefit managers, intermediaries that negotiate prescription-drug benefits and reimbursement arrangements among insurers, drugmakers and pharmacies. In this case, however, the dismissal turned on the procedural history between the parties rather than a judicial determination of whether Express Scripts’ business practices violated antitrust law.

Attorneys leading the case for AHF and Express Scripts did not immediately respond to Courthouse News requests for comment following the decision, the publication reported.

Source: Courthouse News Service