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Pharmacy Sues PBM, Alleges Antitrust Violation

An independent Iowa pharmacy filed suit last week against CVS Health and its pharmacy benefit manager, CVS Caremark, contending that they violated antitrust laws and illegally demanded fees for Medicare-patient prescriptions, according to Axios.

What’s going on: Osterhaus Pharmacy in Maquoketa, Iowa, says “the fees CVS Caremark has been charging independent pharmacies under a Medicare value-based contracting program violate federal antitrust laws and state contract statutes.”

  • Osterhaus says Caremark forced local pharmacies to sign unfair contracts in order to remain in the Caremark network, “putting the pharmacies at a competitive disadvantage,” Health Care Dive reports.

Why it’s important: If the lawsuit prevails, “CVS will have to return hundreds of millions—if not billions—of dollars its PBM recouped from independent pharmacies over the past four years,” according to Axios.

  • PBMs are under increasing scrutiny by Congress, and bipartisan legislation to increase PBM transparency could come up for a vote this year.

The NAM says: “The NAM continues to call on Congress to pass PBM-reform legislation,” said NAM Director of Domestic Policy Julia Bogue.

  • “PBMs drive up the cost of health care by pocketing big discounts from prescription drugmakers instead of passing them on to workers and employers. Manufacturers support reforms that increase PBM transparency and ensure pharmaceutical savings are passed from the PBM to the plan sponsor or the consumer.”
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