Cloney's Pharamacy, Inc. v. Wellpartner, Inc.

CourtDistrict Court, S.D. New York
DecidedSeptember 30, 2024
Docket1:23-cv-10088
StatusUnknown

This text of Cloney's Pharamacy, Inc. v. Wellpartner, Inc. (Cloney's Pharamacy, Inc. v. Wellpartner, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cloney's Pharamacy, Inc. v. Wellpartner, Inc., (S.D.N.Y. 2024).

Opinion

UNITED STATES DISTRICT COURT DELOECCUTMREONNTIC ALLY FILED SOUTHERN DISTRICT OF NEW YORK DOC #: DATE FILED: 9/30/2 024 CLONEY’S PHARAMACY, INC., WILLOW CREEK PHARMACY, INC., and JCH PHARMACY HOLDINGS, INC., on behalf of themselves and all others similarly situated, 1:23-cv-10088-MKV Plaintiffs, OPINION AND ORDER GRANTING -against- MOTION TO STAY IN FAVOR OF ARBITRATION WELLPARTNER, INC. and WELLPARTNER, LLC, Defendants. MARY KAY VYSKOCIL, United States District Judge: Plaintiffs Cloney’s Pharmacy, Inc. (“Cloney’s”), Willow Creek Pharmacy, Inc. (“Willow Creek”), and JCH Pharmacy Holdings, Inc., doing business as Pucci’s Pharmacy (“Pucci’s), three independent pharmacies, bring this putative class action against Defendant Wellpartner, LLC1, a third-party administrator providing services to participants in the federal 340B Drug Pricing Program, alleging that Defendant overcharged Plaintiffs in breach of the parties’ contracts. Defendant moves to dismiss or to stay this action in favor of arbitration. For the following reasons, Defendant’s motion is GRANTED and this case is stayed pending arbitration. FACTUAL BACKGROUND2 Plaintiffs are owners and operators of three independent pharmacies located in and organized under the laws of California. Compl. ¶¶ 2, 13–15. Plaintiffs participate as contract 1 Plaintiffs voluntarily dismissed Defendant Wellpartner, Inc. from this action. [ECF No. 17]. 2 The factual background is drawn from Plaintiffs’ complaint [ECF No. 1 (“Complaint” or “Compl.”)] as well as the parties’ submissions in support of and in opposition to the present motion. See Nicosia v. Amazon.com, Inc., 834 F.3d 220, 229 (2d Cir. 2016). These documents include the following: Defendant’s memorandum of law in support of its motion [ECF No. 19 (“Def. Mem.”)], supported by the Declaration of Katherine Trefz and its exhibits, including the Caremark Provider Agreement (“CPA”) between Caremark and Cloney’s, signed in July 2014 [ECF No. 19-2 (“Cloney’s CPA”)]; the CPA between Caremark and Pucci’s, signed in August 2016 [ECF No. 19-3 (“Pucci’s CPA”)]; pharmacies (“Contract Pharmacies”) in the federal 340B Drug Pricing Program (“340B”), which assists covered healthcare facilities (“Covered Entities) in serving poor and uninsured communities by permitting Covered Entities to purchase certain outpatient prescription drugs at a discount, but be reimbursed for those drugs at the market rate. Compl. ¶¶ 22–23, 34. As Contract Pharmacies, Plaintiffs order, store, and dispense drugs to 340B-eligible patients of the Covered Entities and

collect payment from the patients and their health insurance. Compl. ¶ 31. Defendant, organized under the laws of Delaware with its principal place of business in New York, is the nation’s largest 340B third-party administrator (“TPA”).3 Compl. ¶¶ 2, 17, 47. 340B TPAs like Defendant provide technical, compliance, and administrative services for Covered Entities, including by managing the relationships between Covered Entities and Contract Pharmacies, such as by managing drug inventory, calculating amounts owed on 340B-eligible prescriptions, and coordinating the transfer of those funds from Contract Pharmacies to Covered Entities. Compl. ¶¶ 41–45. As Contract Pharmacies, Plaintiffs entered into Contract Pharmacy Services Agreements (“CPSAs”) with Defendant4 and non-party Covered Entities.5 Compl. ¶¶ 13–15, 49–50. Under

the CPA between Caremark and Willow Creek, signed in October 2020 [ECF No. 19-4 (“Willow Creek CPA”)]; excerpts from the Caremark Provider Manual (“CPM”) as of July 2014 [ECF No. 19-5 (“2014 CPM”)], August 2016 [ECF No. 19-6 (“2016 CPM”)], October 2010 [ECF No. 19-7 (“2010 CPM”)], and 2022 [ECF No. 19-8 (“2022 CPM”)]; and an amendment to the arbitration provision of the CPM effective as of August 10, 2023 [ECF No. 19-9 (“2023 Arbitration Clause”)]; Plaintiffs’ memorandum of law in opposition to the motion [ECF No. 21 (“Pl. Mem.”)] and its exhibits, the Cloney’s Contract Pharmacy Services Agreement (“CPSA”) [ECF No. 21-1 (“Cloney’s CPSA”)]; the Willow Creek CPSA [ECF No. 21-2 (“Willow Creek CPSA”)]; and the Pucci’s CPSA [ECF No. 21-3 (“Pucci’s CPSA”)]; and Defendant’s memorandum of law in further support of its motion [ECF No. 23 (“Def. Reply”)]. 3 Defendant is a wholly owned subsidiary of non-party CVS Health, Inc. (“CVS Health”), which is headquartered and has its principal place of business in Rhode Island. Compl. ¶ 18. 4 The Court notes, however, that Defendant is not a named party to the Willow Creek CPSA. See Willow Creek CPSA 1 (defining “Parties” as the Contract Pharmacy, Willow Creek, and the Covered Entity). 5 Each CPSA contains a choice-of-law provision providing for the application of Oregon law. Cloney’s CPSA ¶ 8.11; Willow Creek CPSA ¶ 8.11; Pucci’s CPSA ¶ 8.11. None of the CPSAs, however, designates a forum—judicial, arbitral, or otherwise—for the resolution of disputes. Each CPSA provides that the CPSA “constitute[s] the entire the CPSAs, Defendant bills Plaintiffs twice per month for payments due in connection with 340B drugs dispensed by Plaintiffs (“Remittances”). Compl. ¶ 52; Cloney’s CPSA ¶ 3.2; Willow Creek CPSA ¶ 3.3; Pucci’s CPSA ¶ 3.2. Remittances “represent the difference between the payments received by Contract Pharmacy from payers and patients, less 340B Contract Pharmacy dispensing fees and credits appropriately applied by [Defendant].” Compl. ¶ 54; Cloney’s CPSA ¶ 3.3; Willow

Creek CPSA ¶ 3.5; Pucci’s CPSA ¶ 3.3. The CPSAs provide that “[a]s invoiced, Contract Pharmacy shall remit to [Defendant] the total amounts collected for each Covered Drug . . . less its Dispensing Fee calculated by [Defendant].” Compl. ¶ 55; Cloney’s CPSA Ex. A ¶ 3.2; Willow Creek CPSA Ex. A ¶ 3.2; Pucci’s CPSA Ex. A ¶ 3.2. After receiving payment from Plaintiffs, Defendant deducts an administrative fee and submits the remainder of the Remittance to the Covered Entity. Compl. ¶ 56. Plaintiffs allege that Defendant erroneously calculated the Remittances by failing to account for “direct and indirect remuneration fees” (“DIR Fees”) that are assessed against Plaintiffs by pharmacy benefit managers (“PBMs”) for drugs dispensed under Medicare Part D,

the outpatient prescription drug benefit for Medicare enrollees. Compl. ¶¶ 4–6, 57–58. DIR Fees are “clawed back” from Contract Pharmacies on Medicare Part D prescriptions after the “point of sale” reimbursement, which is the figure on which Defendant bases its calculation of a Remittance. Compl. ¶¶ 61–66. Thus, Plaintiffs allege, Defendant does not properly calculate the “total amount collected” by Plaintiffs in determining a Remittance as required by the CPSAs, because it fails to account for post-point-of-sale DIR Fees collected by PBMs that impact the “total amount collected,” in turn impacting the Dispensing Fee retained by Plaintiffs. Compl. ¶¶ 66, 69, 71–72,

understanding between the Parties as to their obligations and, unless otherwise specified herein, may not be amended except by a writing signed by both Parties.” Cloney’s CPSA ¶ 8.6; Willow Creek CPSA ¶ 8.6; Pucci’s CPSA ¶ 8.6. 75–82. Accordingly, Plaintiffs allege that Defendant overcharges Plaintiffs, in breach of the CPSAs. Compl. ¶¶ 5, 71, 73, 77, 82, 94, 97. “The largest PBM by market share in the United States are non-parties Caremark, LLC and CaremarkPCS, LLC” (collectively, “Caremark”). Compl. ¶¶ 6, 59. Caremark are Defendant’s “sister companies.” Compl. ¶ 6. Defendant and Caremark “are wholly owned by the parent

company, nonparty CVS Health.” Compl. ¶ 7. Plaintiffs allege that Defendant “is well aware of Caremark’s DIR Fees,” including because CVS Health is “one of the most prolific assessors of DIR Fees” and “CVS Health—not so incidentally the owner of the largest PBM in the nation— purchased [Defendant] in 2017, in or around the same time that DIR Fees came into prominence as a popular moneymaker for PBMs.” Compl. ¶ 67; see also Compl.

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Bluebook (online)
Cloney's Pharamacy, Inc. v. Wellpartner, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/cloneys-pharamacy-inc-v-wellpartner-inc-nysd-2024.