US: Express Scripts is accused of antitrust violation by compounding pharmacies

Compounding pharmacies accuse Express Scripts of conspiring with other giant pharmacy benefit managers to squeeze them out of the market by an illegal boycott, in a federal antitrust complaint.

Precision RX Compounding and five other pharmacies accuse Express Scripts of “an ongoing and multi-faceted conspiracy between the nation’s largest pharmacy benefit managers – including Express Scripts, CVS Health Corporation, OptumRx, Inc., and Prime Therapeutics, LLC -to jointly boycott compounding pharmacies to eliminate plaintiffs from the market for pharmaceuticals covered by group and individual health plans.”

However, only Express Scripts is named as a defendant in the Jan. 15 lawsuit.
Compounding pharmacies, which require special certification, can provide personalized medicine for patients. It is both an art and a science, the Professional Compounding Centers of America say on their website.

They say in the lawsuit: “Through their role as claim administrators for group and individual health plans, Express Scripts and its co-conspirators improperly decide whether and to what extent pharmacies are reimbursed for prescribed and filled drugs.

“Although health plans are financially responsible for covered prescription drugs it is the PBMs that make the decision on whether a certain drug is covered by a specific group or individual health plan. The PBMs such as Express Scripts have inserted themselves as middlemen and act as gatekeepers when patients submit prescriptions to pharmacies.”

Antitrust laws require that PBMs such as Express Scripts unilaterally establish their drug reimbursement and coverage policies, the plaintiffs say.

Full content: BioPharma Dive

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