ALEXANDRIA, Va. (Dec. 19, 2023) – The National Community Pharmacists Association 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, pharmacist, MBA.
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 is Osterhaus Pharmacy of Maquoketa, Iowa, who 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,” Hoey said. “Moreover, those fees do nothing more than line the pockets of PBMs. 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 is often affiliated with other insurance companies. Either way, independent pharmacies are pushed to the brink by these practices.
Pharmacies being pushed to the brink and wanting to fight back should visit www.fightpbms.com.
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Founded in 1898, the National Community Pharmacists Association is the voice for the community pharmacist, representing over 19,400 pharmacies that employ more than 230,000 individuals nationwide. Community pharmacies are rooted in the communities where they are located and are among America’s most accessible health care providers. To learn more, visit www.ncpa.org.
