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Compounding pharmacies sue Express Scripts over 'boycott'

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Six compounding pharmacies have sued Express Scripts Inc. in federal court, alleging in the antitrust suit that the St. Louis-based pharmacy benefit manager conspired with other PBMs to drive compounding pharmacies out of the market.

Express Scripts, CVS Health Corp., OptumRx Inc. and Prime Therapeutics L.L.C. worked to “jointly boycott compounding pharmacies to eliminate plaintiffs from the market for pharmaceuticals covered by group and individual health plans,” according to the suit filed Friday in U.S. District Court in St. Louis.

Express Scripts and Express Scripts Holding Co., which could not be reached immediately for comment, are the only named defendants in the suit.

The plaintiffs allege that Express Scripts and other PBMs shifted filling patients' compound medication prescriptions “to pharmacies in which the defendants and their co-conspirators hold an economic interest,” calling such actions a “horizontal group boycott” of smaller compounding pharmacies.

“Express Scripts is the largest PBM in the nation and its primary co-conspirators are the second-, third- and fourth-largest PBMs,” according to the suit. “Taken together, these PBMs review and make reimbursement decisions on more than 80% of prescription drug claims covered by group and individual plans in this country. Approximately 95% of all prescription drug sales are covered by plans. Thus, if plaintiffs fill prescriptions from plan-covered patients — and they must to survive — they are forced to deal with Express Scripts, its co-conspirators and the terms set by those PBMs.”

Compounded prescriptions are two or more medications that are combined outside their typical, commercially available form, such as pills. Compounds, which often are customized for each patient, include topical creams and gels, injections and oral liquids, anesthetics, anticonvulsants, analgesic painkillers and muscle relaxants.

Pharmacies that dispense compounded drugs typically bill insurers and employers for each ingredient in a prescription. PBMs have worked in recent years to reduce group health and workers compensation spending on such costly prescriptions.

Plaintiffs in the case are seeking unspecified damages and injunctions that would require Express Scripts to process and pay the plaintiffs' claims for compounded drugs.

The plaintiffs include Precision Rx Compounding L.L.C. in Tampa, Florida; C&M Health Pro L.L.C. in Kissimmee, Florida; Northern VA Compounders P.L.L.C. in Chantilly, Virginia; Toth Enterprises II P.A. in Austin, Texas; Austin-based The Daily Dose L.P. and CPRx Pharmacy L.P. of Cedar Park, Texas.

A similar lawsuit was filed in the same court against Express Scripts in 2014. In March 2015, U.S. District Court Judge Henry Edward Autrey denied a request for a preliminary injunction and a temporary restraining order against Express Scripts, and the U.S. 8th Circuit Court of Appeals affirmed that ruling on Jan. 11.