Legal action targets another bad actor, says National Community Pharmacists Association
Alexandria, VA (December 19, 2023) – The National Community Pharmacists Association (NCPA) today cheered another class action lawsuit filed against an insurance behemoth and its pharmacy benefit manager that aims to recoup millions of dollars in backdoor fees on small independent pharmacies.
“After years of abuse at the hands of big insurance plans and their PBMs, independent pharmacies are fighting back,” said NCPA CEO B. Douglas Hoey.
The lawsuit, announced today by the law firms Berger Montague PC and Cohen & Gresser LLP claims that UnitedHealth Group and its PBM, OptumRx, have been assessing pharmacy DIR fees in violation of federal antitrust laws and state laws governing contracts. The plaintiff in the case, Osterhaus Pharmacy of Maquoketa, IA, is also the lead plaintiff in a case against CVS Caremark.
“It’s very common for individual pharmacies to pay hundreds of thousands of dollars a year in fees that they can’t anticipate, and in many cases long after the point of sale. Moreover, those fees do nothing more than line the pockets of PBMs,” said Hoey. “They’re putting small, independent pharmacies out of business, thereby limiting choice and quality for consumers, and we are optimistic that these legal challenges will finally bring some justice to this self-serving practice. We understand litigation can be uncertain and we are thankful for the bravery of Matt Osterhaus in taking on these 21st century robber barons.”
UnitedHealth Group and OptumRx control nearly a third of all prescriptions in the country, and in some areas, they have a virtual stranglehold on the market. Independent pharmacies whose patients are covered by UnitedHealth must either agree to the shakedown as part of a “take-it-or-leave-it” contract, or they must allow their patients to be steered to a large mail-order pharmacy or some other big competitor that are often affiliated with other insurance companies. Either way, independent pharmacies are pushed to the brink by these practices.
Independent pharmacists who want to learn more about their legal options should visit www.fightpbms.com.
For more information about NCPA, please visit www.ncpa.org.
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