Express Scripts Inc. et al.

2023 ME 68, 304 A.3d 239
Supreme Judicial Court of Maine·Decided November 7, 2023·No. BCD-22-331·Published·Cited by 1 cases

Opinion

MAINE SUPREME JUDICIAL COURT Reporter of Decisions Decision: 2023 ME 68 Docket: BCD-22-331 Argued: September 12, 2023 Decided: November 7, 2023 Revised: November 28, 2023

Panel: STANFILL, C.J., and MEAD, JABAR, HORTON, LAWRENCE, and DOUGLAS, JJ.

EXPRESS SCRIPTS INC. et al.

v.

STATE TAX ASSESSOR

JABAR, J.

[¶1] Express Scripts Inc. (ESI) and its unitary Maine affiliates (collectively, Express Scripts) appeal from an order entered in the Business and Consumer Docket (Duddy, J.) granting summary judgment approving the State Tax Assessor’s method of calculating Express Scripts’ Maine tax liability. The Assessor cross-appeals from the trial court’s (Murphy, J.) order sealing certain aspects of the parties’ filings pursuant to Maine Rule of Civil Procedure 56, and the trial court’s (Duddy, J.) subsequent order denying the Assessor’s motion to unseal. We affirm the judgment and the challenged orders.

I. BACKGROUND

[¶2] During 2011, 2012, and 2013 (the Audit Period), ESI was a corporation organized under Delaware law with its headquarters and executive

offices in St. Louis, Missouri. On April 2, 2012, Express Scripts Holding Company, the parent company of ESI, acquired the stock of Medco Health Solutions, Inc., and its affiliates. ESI and its affiliated entities were engaged together in a unitary business that involved business activity both within and outside Maine.1

[¶3] During the Audit Period, Express Scripts sold prescription drugs by mail order delivery and provided infusion services throughout the United States, including Maine. Additionally, Express Scripts sold claims adjudication and other pharmacy benefit management (PBM) services throughout the United States, including in Maine.2 During the Audit Period, Express Scripts

1“Unitary business” is defined by Maine statute as “a business activity which is characterized by unity of ownership, functional integration, centralization of management and economies of scale.” 36 M.R.S. § 5102(10-A) (2023); see also State Tax Assessor v. Kraft Foods Grp., Inc., 2020 ME 81, ¶¶ 19, 38, 42, 235 A.3d 837; Gannett Co. v. State Tax Assessor, 2008 ME 171, ¶¶ 12-13, 959 A.2d 741. “The unitary business concept ignores the separate legal existence of corporations . . . and focuses on such practical business realities as transfers of value among affiliated corporations.” Gannett, 2008 ME 171, ¶ 13, 959 A.2d 741; see Kraft, 2020 ME 81, ¶ 19, 235 A.3d 837.

2 Express Scripts repeatedly attempts to qualify or dispute the Assessor’s description of its business activities by asserting that what it sold was a “core bundle of services.” However, this phrase does not appear in any of Express Scripts’ PBM agreements, invoices, receipts, or any other record material. “[E]xtrinsic evidence is not admissible to explain or alter an unambiguous integrated contract.” Doe v. Lozano, 2022 ME 33, ¶ 17, 276 A.3d 44. The provisions of such contracts must be interpreted “according to [their] plain meaning.” Fortney & Weygandt, Inc. v. Lewiston DMEP IX, LLC, 2019 ME 175, ¶ 34, 222 A.3d 613 (quotation marks omitted). Thus, the affidavits submitted by Express Scripts in support of its “core bundle of services” argument would not be admissible as evidence to explain the contract and transactional material comprising much of the record. See M.R. Civ. P. 56(e). Therefore, Express Scripts’ “core bundle of services” argument has no factual support in the record, and to the extent that Express Scripts uses that phrase in its argument to attempt to create a genuine issue of material fact to survive a motion for summary judgment, the argument fails.

generated revenue primarily from the delivery of prescription drugs through its contracted network of retail pharmacies, from home delivery of prescription drugs, from specialty pharmacy services, and from services in its non-PBM business segment. Revenues from the delivery of prescription drugs to Express Scripts’ members represented 99.4% of revenues in 2011; 99.0% of revenues in 2012; and 98.8% of revenues in 2013.

[¶4] Express Scripts’ “clients” during the Audit Period included health insurers, health maintenance organizations, employers, governmental health programs, and union-sponsored benefits plans. The clients’ “members” were the primary recipients of Express Scripts’ services. If a client was a health insurer, the term “members” referred to the insured individuals; if a client was an employer, then the term “members” referred to the employees covered by the employer’s health plan. The parties agree that, except for pricing, Express Scripts’ agreements with its clients are substantially the same in all material respects. Pursuant to written agreements with retail pharmacies that were in effect during the Audit Period, Express Scripts negotiated the prices at which retail pharmacies would provide prescription drugs to individual members and managed national and regional networks that were responsive to client

preferences related to cost containment, convenience of access for members, and network performance.

[¶5] When a member presented his or her Express Scripts identification card at a retail pharmacy, Express Scripts communicated in real time with the pharmacy to process prescription drug claims at the point of sale. The pharmacist sent the member’s prescription information to Express Scripts through its computer system, and Express Scripts processed the claim and responded back to the pharmacist in real time. This process is referred to as the “adjudication of claims.” The claims-adjudication process included Express Scripts’ (A) confirming the member’s eligibility to the pharmacist; (B) performing a concurrent drug interaction/utilization review; (C) confirming to the retail pharmacy that it would receive payment from Express Scripts pursuant to their agreements, if the claim was accepted; and (D) informing the retail pharmacy of the co-payment amount to be collected from the member.

[¶6] Express Scripts filed its original 2011 Maine corporate income tax return in October 2012 and reported an overall Maine sales factor of 0.008036.3

The sales factor indicates the portion of a corporate taxpayer’s income that is subject to tax in 3

Maine, and is represented as “a fraction, the numerator of which is the total sales of the taxpayer in [Maine] during the tax period, and the denominator of which is the total sales of the taxpayer

In calculating the sales factor on the original 2011 Maine corporate income tax return, Express Scripts apportioned receipts from the performance of its PBM services on a market member basis.4

[¶7] ESI, Medco, and their affiliates filed their 2012 Maine corporate income tax return in October 2013 and reported an overall Maine sales factor of 0.002021. In calculating the sales factor applicable to its portion of the unitary business, Medco apportioned receipts from the performance of its PBM services on a market member basis, but ESI changed the method it used to apportion receipts to calculate its sales factor, apportioning receipts from ESI’s performance of PBM services on a market client basis.5 ESI made this change even though its business operations and the applicable Maine statutes and rules had not changed; and ESI did not notify Maine Revenue Service (MRS) that it

everywhere during the tax period.” 36 M.R.S. § 5211(14) (2023); see Kraft, 2020 ME 81, ¶¶ 1 n.2, 14, 235 A.3d 837.

4 The term “market member basis” describes the method of apportioning receipts from the

performance of PBM services to the state in which the prescription drug is dispensed to members by the retail pharmacies.

5 The term “market client basis” describes the method of apportioning receipts from the performance of PBM services to the location of the primary commercial and administrative headquarters of clients.

had changed its method even though it was obligated by regulation to do so. See 18-125 C.M.R. ch. 801, § .05 (effective Mar. 19, 2011).6

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

Express Scripts Inc. et al., 2023 ME 68, 304 A.3d 239 (Me. 2023).

2023 ME 68 (Express Scripts Inc. et al.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Michael Good v. Town of Bar Harbor
2024 ME 48 (Supreme Judicial Court of Maine, 2024)