Caremark LLC v. AIDS Healthcare Foundation

CourtDistrict Court, D. Arizona
DecidedSeptember 15, 2022
Docket2:21-cv-01913
StatusUnknown

This text of Caremark LLC v. AIDS Healthcare Foundation (Caremark LLC v. AIDS Healthcare Foundation) is published on Counsel Stack Legal Research, covering District Court, D. Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Caremark LLC v. AIDS Healthcare Foundation, (D. Ariz. 2022).

Opinion

1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA

9 Caremark LLC, et al., No. CV-21-01913-PHX-DJH

10 Petitioners, ORDER

11 v.

12 AIDS Healthcare Foundation,

13 Respondent. 14 15 At issue before the Court is whether to confirm or vacate the arbitration award issued 16 on November 12, 2021, against Petitioners Caremark LLC and Caremark PCS LLC 17 (collectively, “Caremark”). On November 12, 2021, Caremark filed an Amended Motion 18 to Vacate or Correct the Arbitration Award (“Motion to Vacate”) on the ground that the 19 arbitrator exceeded his authority (Doc. 12). In addition to responding to the Motion to 20 Vacate, Respondent AIDS Healthcare Foundation (“AHF”) filed a cross Motion to 21 Confirm the Final Award and Entry of Judgment (“Motion to Confirm”) (Doc. 72).1 Both 22 motions are fully briefed. (See Docs. 58, 59, 75, 76). 23 In its initial filing, Caremark also sought to seal this entire action, which the Court 24 subsequently denied. (Doc. 49). The Court did, however, allow Caremark to file redacted 25 versions of documents describing Caremark’s “incentive-fee formulas” because it found 26 Caremark had made an initial showing that its competitors could obtain an advantage if the

27 1 Caremark requested oral argument on the matter. The Court finds that the issues have been fully briefed and oral argument will not aid the Court’s decision. Therefore, the Court 28 will deny Caremark’s request for oral argument. See Fed. R. Civ. P. 78(b) (court may decide motions without oral hearings); LRCiv 7.2(f) (same). 1 formulas were released to the public. (Doc. 49 at 5) (stating that “at least for now, the 2 incentive-fee formulas and the reimbursement rates should be shielded from public view”). 3 The Court then issued an Order that permitted the following docket numbers to remain 4 under seal, without prejudice to later move to unseal: 6, 12, 22, 24, 28, 31, 33, 34, 36, 37, 5 40, and 46. (Doc. 66). 6 Caremark now brings a Motion for Protective Order, which seeks to retain the 7 redactions to those documents. (Doc. 67). As discussed below, the Court finds that any 8 sealing of documents relating to this case is no longer justified and will order the documents 9 listed above to be unsealed. 10 I. Background2 11 A. The Parties 12 a. AIDS Healthcare Foundation 13 AHF owns and operates retail pharmacies that serve HIV/AIDS patients, including 14 patients enrolled in Medicare Part D prescription drug program.3 (Doc. 12-9 at 16). Each 15 AHF-affiliated pharmacy submits claims to Caremark for reimbursement. (Id.) 16 b. Caremark 17 Caremark contracts with prescription drug plan sponsors to provide pharmacy 18 benefit management services to the plan’s members. (Id.) Caremark is a pharmacy benefit 19 manager (“PBM”). In this role, it manages the prescription drug benefits of its clients, 20 which includes, as relevant here, government prescription drug plan sponsors. (Id.) 21 Caremark offers several services to its clients, including the administration and 22 maintenance of nation-wide pharmacy networks to provide pharmacy access to its clients’ 23 members. (Id. at 17). Caremark has over 68,000 pharmacies enrolled in its various 24 networks, including AHF-affiliated pharmacies. (Id.)

25 2 The Court will adopt portions of the background section from the arbitrator’s Final Award Stipulated Facts section. (Doc. 12-9 at 16–25). Unless noted otherwise, all facts contained 26 herein are stipulated.

27 3 Medicare Part D provides outpatient prescription drug coverage to Medicare beneficiaries enrolled in private plans. See 42 U.S.C. §1395, et seq. A Part D plan, which is an insurance 28 plan for prescription drugs, is also a contract that a plan sponsor enters with the Department of Health and Human Services. (Doc. 72 at 9). 1 c. Reimbursement Claims 2 Under the various contract documents, pharmacies agree to provide services in 3 accordance with the terms of those agreements. (Id.) When a customer fills a prescription 4 at a Caremark network pharmacy, (e.g., an AHF-affiliated pharmacy), the pharmacy 5 submits a reimbursement claim to the customer’s prescriptions insurance plan via 6 Caremark, and Caremark adjudicates the claim on behalf of its client—the plan sponsor. 7 (Id.) 8 This process confirms the prescribed product is covered by the customer’s health 9 plan and advises the pharmacy the reimbursement rate at the point of service for the drug 10 in addition to the amount of co-pay the pharmacy should collect from the customer based 11 on its plan coverage. (Id.) 12 B. AHF’s Dispute 13 This case arises from an arbitration between the parties involving a breach of 14 contract claim. (Id.) 15 At issue was Caremark’s operation of the Performance Network Program (“PNP”). 16 Under the PNP, Caremark was authorized to take back from pharmacies like AHF public 17 Medicare Part D monies earmarked to pay for prescriptions for people of limited financial 18 means. (Id.) Caremark then paid that money back to the Part D plan sponsors. The result 19 was that pharmacies like AHF received less money than the Part D plan sponsors, who 20 received the negotiated reimbursement rates for public Part D monies. (Id.) 21 AHF alleged the manner in which Caremark applied the PNP breached the 22 agreement between AHF and Caremark and the covenant of good faith and fair dealing. 23 (Id.) AHF also sought a permanent injunction prohibiting Caremark from operating the 24 PNPs and sought damages arising out of Caremark’s performance network fees (“PNR 25 Fees”) assessed to the pharmacies from January 1, 2016, to 2020. (Id.) 26 A. Provider Agreements 27 Beginning in 2007 and prior to November of 2019, each AHF-affiliated pharmacy 28 entered a separate “Provider Agreement” with Caremark to participate in Caremark’s 1 Networks. (Id. at 18). On or about November 4, 2019, the AHF pharmacies became a 2 pharmacy chain in Caremark’s Networks, and Caremark and AHF executed four provider 3 chain agreements (“Chain Provider Agreements”). (Id.) 4 The contract between AHF and Caremark included four documents: 5 (1) the Provider Agreements—used to sign up service providers, like AHF, so those 6 providers can participate in Caremark’s pharmacy networks (prior to November 7 4, 2019); 8 (2) the Chain Provider Agreements (after November 4, 2019); 9 (3) the Caremark Provider Manuals; and 10 (4) the Caremark Network Enrollment Forms (“NEFs”) used by Caremark to enroll 11 providers, like AHF, in specific Medicare Part D networks. 12 (Id. at 18–19).4 13 The Provider Manual contains various arbitration provisions, which state, “the 14 award of the arbitrator(s) will be final and binding on the parties, and judgment upon such 15 award may be entered in any court having jurisdiction thereof.” (Doc. 12-6 at 118). 16 B. Caremark’s Performance Network Program and Network Enrollment Forms 17 (“NEF”) 18 On July 1, 2016, select Caremark Medicare Part D pharmacy networks became part 19 of Caremark’s PNP. (Doc. 12-9 at 24). To join the PNP, Caremark provided AHF with a 20 NEF, which set forth the rates that Caremark used to reimburse AHF’s pharmacies for the 21 filling of prescriptions for a particular year. (Id. at 69). Under the PNP, Caremark 22 reimbursed pharmacies with a point-of-sale rate in conjunction with a set network fee, 23 which was assessed at the point of sale. (Id. at 24). 24 On January 1, 2016, instead of assessing a flat network fee, pharmacies were 25 assessed a variable network fee range, contingent on their performance metrics, with the 26 higher performing pharmacies paying the lower fee. (Id.) Under this scheme, Caremark 27 calculated the participating pharmacies scores per the PNP’s criteria and used those scores

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Nixon v. Warner Communications, Inc.
435 U.S. 589 (Supreme Court, 1978)
Lagstein v. CERTAIN UNDERWRITERS, LLOYD'S, LONDON
607 F.3d 634 (Ninth Circuit, 2010)
Biller v. Toyota Motor Corp.
668 F.3d 655 (Ninth Circuit, 2012)
Vanessa Menke v. Eric Monchecourt
17 F.3d 1007 (Seventh Circuit, 1994)
Vernon Vu Luong v. Circuit City Stores, Inc.
368 F.3d 1109 (Ninth Circuit, 2004)
Welch v. Metropolitan Life Ins. Co.
480 F.3d 942 (Ninth Circuit, 2007)
Comedy Club, Inc. v. Improv West Associates
553 F.3d 1277 (Ninth Circuit, 2009)
In Re Bosack v. Soward
586 F.3d 1096 (Ninth Circuit, 2009)
Collins v. D.R. Horton, Inc.
505 F.3d 874 (Ninth Circuit, 2007)
Creative Builders, Inc. v. Avenue Developments, Inc.
715 P.2d 308 (Court of Appeals of Arizona, 1986)
MicroStrategy, Inc. v. Business Objects, S.A.
331 F. Supp. 2d 396 (E.D. Virginia, 2004)
Aron Oliner v. John Kontrabecki
745 F.3d 1024 (Ninth Circuit, 2014)

Cite This Page — Counsel Stack

Bluebook (online)
Caremark LLC v. AIDS Healthcare Foundation, Counsel Stack Legal Research, https://law.counselstack.com/opinion/caremark-llc-v-aids-healthcare-foundation-azd-2022.