Independent Pharmacies Sue Major PBM Over Alleged Illegal Price Discrimination And Reimbursement Violations

PHILADELPHIA, May 15, 2020 /PRNewswire/ -- The newest litigation against a major pharmacy benefit manager (PBM) comes from a likely source: its small business victims. More than 50 independent pharmacies have filed a class action lawsuit against OptumRx, a division of UnitedHealth Group, after the company's failure to comply with state pharmacy claims reimbursement law.

The lawsuit alleges OptumRx acted unlawfully by ignoring state legal requirements, paying local pharmacies substantially less than it paid large chain retail pharmacies like CVS or Walgreens and far below what it paid its own mail order pharmacy for the same prescriptions. The lawsuit further alleges OptumRx often knowingly reimbursed local pharmacies below wholesale cost to stock necessary generic prescription drugs.

PBMs administer the prescription drug portion of health insurance and self-insured plans, acting as a middleman between the insurance plan and the pharmacist. Over the last 20 years these companies have accumulated immense, unregulated power - the three largest PBMs controlling up to 80% of the healthcare market - and have utilized that power to increase prescription drug costs, decrease competition and restrict patient choice.

Plaintiffs involved in the lawsuit allege that:

• Reimbursements are dictated without notice or proper contractual negotiation, and often the dictated rates are grossly unrelated to the pharmacies' actual wholesale acquisition costs
• Optum engages in a pattern of conduct where health care plans are charged brand prices while pharmacies are paid the lower generic price per prescription.  Thus, the pharmacies allege the company is arbitraging prescriptions merely by changing its description.
• Optum intentionally built a wall of secrecy around its conduct by forcing network pharmacies into confidentiality agreements that illegally conceal the truth about Optum's business practices – specifically how much Optum is paid by insurance plans for prescriptions, how much Optum receives in rebates from drug manufacturers, and how little Optum pays to pharmacies

The pharmacies are represented by Mark Cuker and Neal Jacobs of the Jacobs Law Group, which represents over 400 pharmacies in lawsuits pending in Federal Court in Pennsylvania. For more information about the lawsuit, contact Mark Cuker at (215) 531-8522.

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SOURCE Pharmacists United for Truth and Transparency