Independent drugstores are opening up a new front in their battle against pharmacy benefit managers.
The National Community Pharmacists Association, which represents more than 19,400 pharmacies, has formed a limited liability company that aims to recover direct and indirect remuneration fees from PBMs.
Related: Congress eyes endgame for PBM legislation
The company, Trust LLC, will investigate and potentially litigate or arbitrate on behalf of community pharmacies to recoup some fees, which the association said have been wrongfully assessed by PBMs in violation of federal antitrust and state contract laws and have put pharmacies at a competitive disadvantage. Trust LLC provides a way for community pharmacies to assign their claims against PBMs.
“PBMs shouldn't be able to make assessing junk DIR fees against competing pharmacies a multi-billion dollar cottage industry that puts their competition out of business and compromises patient care,” said association CEO B. Douglas Hoey in a news release. “It’s completely anti-competitive, and we’re fighting back.”
The Pharmaceutical Care Management Association, which represents PBMs, defended the purpose of DIR fees in an emailed statement. The programs reduce patient out-of-pocket costs in Medicare and protect health plans and patients from drug price variation in the commercial market, said spokesperson Greg Lopes.
If an arbitration is successful, then Trust LLC would pay the attorneys’ fees and costs incurred and then give the remaining money to the pharmacy, according to the association.
Attorneys at Berger Montague PC, Cohen & Gresser LLP and Baker Donelson will represent Trust LLC. “The purpose of setting up the ability for pharmacies to assign their claims is to basically take that burden off the shoulders of these smaller pharmacies,” said Katie Funk, a partner with Baker Donelson.
Funk estimated that on average, a single community pharmacy pays $100,000 to $150,000 in fees annually per PBM.
The association's move follows recent efforts to rein in PBMs and how they're using the fees. Last month, a lawsuit seeking class-action status was filed against CVS Health, Caremark and Aetna alleging the Caremark PBM has been wrongfully charging DIR fees.
