On Wednesday, a case was filed between Lackie Drug Store Inc. and the pharmacy benefit management companies ARKANSAS CVS PHARMACY, L.L.C., CVS HEALTH CORPORATION, CAREMARK, L.L.C., CAREMARKPCS, L.L.C., EXPRESS SCRIPTS, ESI MAIL PROCESSING, INC., ESI MAIL PHARMACY SERVICE, INC., EXPRESS SCRIPTS PHARMACY, MEDIMPACT HEALTHCARE SYSTEMS, INC., MEDIMPACT DIRECT, LLC, OPTUMRX, INC., OPTUMRX PHARMACY, INC., and PHARMACEUTICAL CARE MANAGEMENT ASSOCIATION (PBMs). This case, filed in the Circuit Court of Lonoke County, Arkansas, alleges anticompetitive behavior on the part of the PBMs regarding their reimbursement methodologies and practices toward pharmacies.
When a patient has health insurance, the pharmacy costs, reimbursements, and contracting is usually managed by a specialized pharmacy benefit manager, either a third company or a specialized department, on behalf of the insurance company. These PBMs utilize a chart of Maximum Allowable Costs (MAC) based upon factors such as the average wholesale price, Medicaid reimbursement rates, and other methodologies to determine the reimbursement rate given to pharmacies for fulfilling the prescription. However, Lackie alleges that this MAC is not being made available during contract negotiations or during benefit verification, so Lackie is unable to negotiate better rates, or refuse to provide services that are unprofitable. The plaintiff also alleges direct conspiracy regarding the pricing rates, as the Arkansas code mandates that the MAC chart be provided in a timely manner to prevent unfair competition.
The plaintiff alleges five separate counts, including failure to reimburse equivalent services at the same rate under Arkansas Code §17-92-507(d)(l), failure to provide MAC in a timely manner under §17-92-507(g)(l), anticompetitive and monopolistic trade practices under §4-75-202, conspiracy to commit unfair trade practices, and for declaratory relief. Plaintiff is being represented by Clarke Tucker Law, Wylyrommel Firm, and the Poynter Law Group.
