Six Compounders Sue Express Scripts
Six compounders are suing Express Scripts, accusing the nation’s largest PBM of participating in a massive conspiracy to put independent compounders out of business.
The lawsuit filed in U.S. District Court for the Eastern District of Missouri contends that Express Scripts and other major PBMs violated the Sherman Antitrust Act by collectively boycotting independent businesses in favor of compounding operations under their direct control.
The two-count document asks the court to prohibit Express Scripts from engaging in alleged anticompetitive behavior, award the compounders compensatory damages and treble actual damages for the company’s alleged flouting of the Sherman Antitrust Act.
Although the lawsuit makes repeated references to a conspiracy between several PBMs to jointly boycott compounding pharmacies to eliminate independent compounders from the market, only Express Scripts is named as a defendant.
The plaintiffs in the suit are Precision Rx Compounding, C&M Health Pro, Northern VA Compounders, TOTH Enterprises II, The Daily Dose and CPRx Pharmacy.
The suit frames the issue as an existential battle rather than a simple dispute over market share, contending that because these PBMs set the policies for 95 percent of all U.S. healthcare plans, their alleged tactics “have devastated” independent compounders.
“As a result of the agreement between Express Scripts and its co-conspirators to exclude [independent compounders] from various prescription drug markets, competition in those markets has been reduced, the supply of medically beneficial compounded products has decreased and faces near elimination,” the suit states.
The document alleges that the PBMs utilized “a series of unreasonable restrictions and rules that would make it impossible for [independent compounders] to fill prescriptions for plan-covered patients and obtain reimbursements that would cover their costs.”
These supposed tactics include forcing physicians that prescribe compounded drugs to stop, making “misleading statements to patients” about the safety and legality of compounding, eliminating coverage for compounded drugs or denying claims for them, drastically reducing reimbursement rates for compounded drugs, orchestrating “onerous procedural and administrative obstacles,” auditing compounding operations over prescriptions that had been filled months earlier and removing compounding pharmacies from their coverage networks altogether.
Representatives of Precision Rx Compounding could not be reached for comment and Northern Virginia Compounders did not return a message seeking comment.
Express Scripts said that it would “vigorously defend” itself against the allegations in the suit, adding that the company works to “reduce any wasteful spending on compounded medications and continue to ensure patient access to cost-effective and clinically effective medications.”
Read the lawsuit here: www.fdanews.com/01-21-16-Lawsuit.pdf.