Six compounding pharmacies say Express Scripts and other pharmacy benefit managers tried to force them out of business by denying coverage of their products and telling physicians to stop prescribing compounded drugs.
CVS Health Corp., Express Scripts, OptumRx and Prime Therapeutics 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 that alleges a violation of antitrust laws.
The suit, filed in a federal court in Missouri last week, stems from Express Scripts' move in 2014 to drop coverage for 1,000 ingredients found in compounded drugs. The company stated that it was a response to the rising costs of compound medications, which had increased from an average of $90 to $1,100 per prescription, according to the company.
Express Scripts estimated the move would save up to 95% of costs associated with compounded medications while impacting just 0.6% of patients.
Express Scripts and Express Scripts Holding Co. are the only named defendants in the suit. Fellow pharmacy benefit managers OptumRx, CVS Health and Prime Therapeutics were also accused in the lawsuit of conspiring to shift the filling of patient prescriptions to pharmacies where they “hold an economic interest."
The companies are seeking unspecified damages and injunctions that would require Express Scripts to pay the plaintiffs' claims for compounded drugs. The plaintiffs include Precision Rx Compounding in Tampa, Fla.; C&M Health Pro in Kissimmee, Fla.; Northern VA Compounders in Chantilly, Va.; Toth Enterprises II and the Daily Dose, both in Austin, Texas; and CPRx Pharmacy of Cedar Park, Texas.
Compounds, which often are two or more drugs mixed and customized for each patient, include topical creams and gels, injections and oral liquids.
Express Scripts is not the first PBM to restrict coverage on compounding pharmaceuticals. In 2013 OptumRx, the PBM division for health insurer UnitedHealth Group, stopped covering ingredients used in compounded over-the-counter vitamins and supplements, as well as chemicals used for making cosmetic products and medications not approved by the U.S. Food and Drug Administration.
Compounding pharmacies have been under scrutiny over the past several years regarding safety issues that date back to a 2012 incident in which former Massachusetts pharmacy New England Compounding Center was found to have sent out steroid injections that were contaminated with fungal meningitis, resulting in 64 deaths and more than 700 people in several states getting sick.
