Prime Loses Motion; Will Face PBM Price-fixing Arbitration Brought by AHF
2024年7月20日 - 2:40AM
ビジネスワイヤ(英語)
Arbitrator denies Prime’s second attempt to
dismiss case for fixing, with a direct business competitor, Express
Scripts, reimbursement rates paid to independent pharmacies like
AHF
AIDS Healthcare Foundation (AHF), the leading provider of health
care to people living with HIV/AIDS around the world, notched
another significant legal victory in an American Arbitration
Association arbitration against Prime Therapeutics LLC, one of the
nation’s largest pharmacy-benefits managers (PBMs), which for over
four years has been in a questionable business “collaboration” with
Express Scripts, Inc. (“ESI”), a direct business competitor. On
July 10, 2024, Arbitrator Stuart M. Widman issued a ruling denying
Prime’s motion for summary adjudication, allowing the formal
arbitration process to move forward.
In June 2023, AHF defeated Prime’s previous attempt to end the
entire case, and AHF was allowed to proceed against Prime on claims
of antitrust violations, price-fixing with ESI, and other civil
wrongs. Arbitrator Cohen retained five of AHF’s seven claims,
dismissing only two. (Arbitrator Cohen stepped down as arbitrator
shortly afterward.)
Earlier this summer, Prime moved for summary adjudication
seeking to have the remaining five claims dismissed, and Arbitrator
Widman denied motion.
“Arbitrator Widman, in summary, states that he is leaning toward
finding that the Prime-ESI ‘collaboration’ is a per-se (automatic)
illegal horizontal price-fixing conspiracy,” said Jonathan M.
Eisenberg, Deputy General Counsel for AHF. “This ruling is a
terrific outcome in the David and Goliath battle that pharmacies
like AHF and others must wage against PBMs to survive. We look
forward to now proving our claims in the next phase of the
arbitration later this summer.”
Background
Prime is a pharmacy-benefits manager (PBM), a “middleman” in the
distribution system for prescription drugs in the United States.
Prime acts as a gatekeeper between pharmacies and health insurers.1
Prime boasts of administering the pharmacy-benefits components of
health-insurance plans for about 38 million people in the United
States. Many of those people are patients of AHF pharmacies. Since
2020, AHF has filled hundreds of thousands of drug prescriptions
for patients whose PBM is Prime.
Since April 2020, Prime has been deliberately aligning its
pharmacy reimbursement rates with those set by ESI. The two PBMs
are no longer doing what they are supposed to be doing in a
free-market system, namely competing on price to attract pharmacies
into provider networks. This scheme harms not only AHF and other
pharmacies directly but also ultimately harms patients and the
entire prescription-drug pipeline in this country.
“AHF continues to have real reason to fear that we may face
retaliation from Prime (and ESI) for exposing the price fixing,”
added Eisenberg. “However, we take that risk on behalf of the
patients we serve and the many other affected independent
pharmacies, to try to stop Prime’s unlawful scheme.”
- July 10, 2024, Prime/AHF arbitration summary adjudication
ruling link
- June 20, 2023 Prime/AHF arbitration dismissal motion ruling
link
AIDS Healthcare Foundation (AHF), the world’s largest
HIV/AIDS healthcare organization, provides cutting-edge medicine
and advocacy to more than 2 million individuals in 47 countries in
the US, Africa, Latin America/Caribbean, the Asia/Pacific Region,
and Eastern Europe. To learn more about AHF, visit us online at
AIDShealth.org, find us on Facebook, follow us on Instagram and
Twitter, and subscribe to our Ahfter Hours podcast.
___________
1 Note: Prime is, in fact, owned by a group of Blue Cross and/or
Blue Shield health insurers.
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version on businesswire.com: https://www.businesswire.com/news/home/20240719156167/en/
Ged Kenslea, AHF Senior Communications Dir. gedk@aidshealth.org
(323) 791-5526