AMERISOURCEBERGEN DRUG CORPORATION v. PRIMROSE PHARMACY, LLC

CourtDistrict Court, E.D. Pennsylvania
DecidedNovember 30, 2021
Docket2:16-cv-06106
StatusUnknown

This text of AMERISOURCEBERGEN DRUG CORPORATION v. PRIMROSE PHARMACY, LLC (AMERISOURCEBERGEN DRUG CORPORATION v. PRIMROSE PHARMACY, LLC) is published on Counsel Stack Legal Research, covering District Court, E.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
AMERISOURCEBERGEN DRUG CORPORATION v. PRIMROSE PHARMACY, LLC, (E.D. Pa. 2021).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA

AMERISOURCEBERGEN DRUG : CORPORATION : : v. : CIVIL ACTION NO. 16-6106 : PRIMROSE PHARMACY, LLC, : ET AL. :

McHUGH, J. November 30, 2021

MEMORANDUM

This is a non-jury case arising out of a contract dispute between an independent pharmacy and the intermediary that provided claims payment processing and network access for the pharmacy. That pharmacy, Defendant Primrose, and its principals have sought to avoid paying Plaintiff AmerisourceBergen Drug Corporation (“ABDC”), the intermediary pharmacy services administration organization (“PSAO”), for debts incurred pursuant to the agreements between them. Specifically, Primrose disputes its obligation to pay back ABDC for an audit recovery charge paid by ABDC on Primrose’s behalf to a third-party, Caremark, on the grounds that Caremark improperly submitted the charge through ABDC. The relationships between these parties are defined by a complex series of interlocking agreements. An arbitration between Primrose and Caremark recently concluded, and ABDC now moves for summary judgment on the basis of its agreements with Primrose. Having carefully reviewed the controlling contracts in light of the record, I conclude that ABDC made the payment in dispute on Primrose’s behalf to Caremark pursuant to authority expressly granted to it by Primrose. Under the terms of the parties’ agreements, I therefore find that Primrose is in breach of its duty to reimburse ABDC for the contested payment. For reasons discussed below, I also conclude that the 18% interest provisions and the litigation costs and attorneys’ fees provisions of both the Credit Agreement and the Master Program Agreement apply to the debt at issue, that Defendants Karl Blass-Schutz and Karl Bucholz are liable for the debts pursuant to their Personal Guaranty, and that Defendant Althea Group, LLC, is also liable pursuant

to the guaranty it signed. Given the clarity of the agreements and lack of any material issue of fact, I will grant Plaintiff’s Motion for Summary Judgment on Counts I, III, and IV of the Complaint in full. I. Factual Allegations and Procedural Posture A. The Agreements On January 14, 2013, ABDC and Primrose initiated a business relationship that would continue until the events that gave rise to this prolonged dispute in late 2016. The relationship began with a Credit Application, Credit Agreement, and a Personal Guaranty signed by Defendants Karl Blass-Schutz and Karl Bucholz, who were the principals of Primrose. ECF 111-1 at 2 (Credit Application), at 3-5 (Credit Agreement), and at 6 (Personal Guaranty). The Credit Agreement

provided the basic mechanism by which ABDC could charge Primrose for goods and services that Primrose obtained through ABDC. The terms of the Credit Agreement, on their face, “appl[ied] to all purchases of goods and services” absent a superseding agreement. Credit Agreement ¶ 1. It contemplated the possibility of chargebacks submitted by third-party manufacturers and buying groups, id., established ABDC’s right to security interests, id. ¶ 2, and required the maintenance of “insurance sufficient to cover all indebtedness to ABDC,” id. ¶ 3. Importantly for this dispute, it included an 18% APR interest fee for late payments, id. ¶ 1, and a fees and costs provision related to any collection efforts, id. ¶ 6. It concluded with a standard integration clause, limiting the terms of the contract to the understandings set forth in the agreement. Id. ¶ 12. The Personal Guaranty was signed at the same time as the Credit Agreement and was expressly identified as “an inducement for [ABDC] to extend credit to Applicant.” ECF 111-1, at 6. In the guaranty, Defendants Blass-Schutz and Bucholz agreed to “guarantee, as sureties, to ABDC … the prompt and full payment (and not merely the ultimate collection) and performance of all Obligations (as

defined in the attached Credit Agreement) of Applicant to ABDC.” Id. In the beginning of February 2013, Primrose and ABDC entered into an additional series of agreements that provided Primrose access to the Pharmacy Services Administration Organization (“PSAO”) network that ABDC managed. These agreements included the Master Program Agreement (“MPA”), ECF 106, Ex. C, and the Elevate Term Sheet, ECF 106, Ex D. (collectively the “PSAO agreements”). The MPA included provisions for Primrose’s obligations to pay fees and other costs associated with participation in any given Pharmacy Benefits Manager (“PBM”) network, MPA ¶ 4, as well as interest penalties for late payments, id., Ex. C ¶ 2.0. It also indemnified ABDC, id., Ex. C ¶ 6.0, and provided for litigation costs and attorneys’ fees, id., Ex. C ¶ 8.6. Around this same time, a series of agreements were either already in effect or then

entered into between ABDC and Caremark, and between Primrose and Caremark. These agreements granted Primrose the capacity to submit pharmacy benefits claims to the Caremark Network, for which Caremark acted as the PBM. These agreements included the Caremark Provider Agreement between Caremark and Primrose, ECF 109-6,1 the Administrator Agreement between Caremark and ABDC, ECF 109-4, and the Agency Addendum to the Caremark Provider Agreement between Caremark and Primrose, with the signed consent of ABDC, ECF 109-5.

1 The record also includes the CVS/Caremark Provider Manual at ECF 109-7 (first half) and ECF 109-16 (second half), which expands upon the Provider Agreement and details, among other things, the process for submitting prescription benefits claims. Its relevance to the present dispute is limited to the termination provisions that governed Primrose’s participation in Caremark’s program. ECF 109-7 at 34. Taken together, these agreements governed Primrose’s access to Caremark’s service as a PBM and ABDC’s role as Primrose’s agent and payment processor when accessing that service. Caremark, as a PBM, provided an interface between insurance companies and pharmacies. Pharmacies make claims to Caremark as a PBM for prescription medicines sold to insured

individuals and Caremark in turn processes those claims, reimbursees the pharmacies, and charges the insurance plans. The key service in this exchange that ABDC provides as a PSAO is to enroll independent pharmacies in PBM networks, such as Caremark’s, and act as a payment processor between the pharmacies and the PBMs. As a PSAO, ABDC thus streamlines reimbursement processing for independent pharmacies and enables efficiencies in payment reconciliation with the PBMs by aggregating many smaller pharmacies into a central accounting mechanism. In the agreements at issue, the central accounting mechanism was referred to as “Central Payment.”2 The Central Payment mechanism formed a core element of the agreements among the parties. In the Administrator Agreement, ABDC and Caremark agreed that ABDC, as the agent of all the individual pharmacies, would use Central Payment to collectively reconcile the

aggregated accounts of all the pharmacies in ABDC’s PSAO network that made claims through Caremark. ECF 109-4, ¶ 1(a) (“Administrator further represents and warrants to Caremark that it has the requisite legal authority to act on each Participating Provider’s behalf to receive all payments made by Caremark for Pharmacy Services performed by Participating Provider (‘Central Payment’) pursuant to the Provider Agreement. The Central Payment is an aggregate payment representing the amounts payable to all Participating Providers who have designated Administrator as their agent for Central Payment pursuant to that Agency Addendum.”). In the Elevate Term

2 Some of the contracts refer to the mechanism as “Central Pay” and others as “Central Payment.” For simplicity’s sake, I will solely refer to it as “Central Payment” except when quoting specific contractual language where I will preserve the original.

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Bluebook (online)
AMERISOURCEBERGEN DRUG CORPORATION v. PRIMROSE PHARMACY, LLC, Counsel Stack Legal Research, https://law.counselstack.com/opinion/amerisourcebergen-drug-corporation-v-primrose-pharmacy-llc-paed-2021.