Express Scripts, Inc. v. Del. State Empl. Benefits Comm.

CourtCourt of Chancery of Delaware
DecidedDecember 13, 2021
DocketC.A. No. 2021-0434-KSJM
StatusPublished

This text of Express Scripts, Inc. v. Del. State Empl. Benefits Comm. (Express Scripts, Inc. v. Del. State Empl. Benefits Comm.) is published on Counsel Stack Legal Research, covering Court of Chancery of Delaware primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Express Scripts, Inc. v. Del. State Empl. Benefits Comm., (Del. Ct. App. 2021).

Opinion

COURT OF CHANCERY OF THE STATE OF DELAWARE KATHALEEN ST. JUDE MCCORMICK LEONARD L. WILLIAMS JUSTICE CENTER CHANCELLOR 500 N. KING STREET, SUITE 11400 WILMINGTON, DELAWARE 19801-3734

December 13, 2021

Michael P. Kelly, Esquire Daniel B. Rath, Esquire Andrew S. Dupre, Esquire Rebecca L. Butcher, Esquire Travis Ferguson, Esquire Jennifer L. Cree, Esquire McCarter & English, LLP Landis Rath & Cobb LLP 405 North King Street, 8th Floor 919 Market Street, Suite 1800 Wilmington, DE 19801 Wilmington, DE 19801

Patricia A. Davis, Esquire Lawrence W. Lewis, Esquire Zi-Xiang Shen, Esquire Delaware Department of Justice 820 North French Street, 6th Floor Wilmington, DE 19801

Re: Express Scripts, Inc. v. Del. State Empl. Benefits Comm., C.A. No. 2021-0434-KSJM

Dear Counsel:

This letter resolves the plaintiff’s motion for summary judgment. Plaintiff Express

Scripts, Inc. (“ESI”) filed this action alleging that the Defendant State Employee Benefits

Committee (the “SEBC”) violated the Procurement Statute when awarding the contract for

the State of Delaware’s Pharmacy Benefit Manager (“PBM”).

On June 23, 2021, I denied ESI’s motion to preliminarily enjoin the transition to the

successful bidder, Defendant CaremarkPCS Health, L.L.C. (“CVS”). In a bench ruling, I

found that ESI was likely to succeed on aspects of its claim, and assumed for the sake of

analysis that ESI would face irreparable harm, but concluded that the balance of equities

required denying the preliminary injunction. When balancing the equities, I observed that C.A. No. 2021-0434-KSJM December 13, 2021 Page 2 of 32

a preliminary injunction threatened harm to over 129,000 members served by the contract

and could result in a potential disruption of pharmacy benefits. This letter decision assumes

that the reader is familiar with the June 23, 2021 bench ruling (the “PI Ruling”).1

At the conclusion of the PI Ruling, I invited ESI to seek an interlocutory appeal.

ESI instead moved for summary judgment on its claim for a permanent injunction. The

standard applied at the preliminary injunction phase is more favorable to the movant than

the standard applied on a motion for summary judgment. The former requires a reasonable

probability of success on the merits. The latter requires actual success on the merits based

on undisputed facts.

This begs the question: What has changed since the preliminary injunction phase to

justify granting ESI, under a more onerous standard, that which it was denied before? The

short answer is: not much. The factual record is largely the same because the parties opted

to forego discovery after the preliminary injunction phase. Nor have the legal arguments

changed significantly.

The only meaningful difference lies in ESI’s requested relief. Before, ESI sought

to preliminarily enjoin the transition to CVS for the Commercial population, which was to

occur by July 1, 2021. Now, ESI seeks a court-ordered reevaluation of proposals, ideally

before July 1, 2022, when the second year of the CVS contract takes effect. ESI argues

1 See C.A. No. 2021-0434-KSJM Docket (“Dkt.”) 61. C.A. No. 2021-0434-KSJM December 13, 2021 Page 3 of 32

that it has met the standard for achieving what, in its view, is a more modest request for

relief.

In my view, ESI’s motion falls short again. The pared back relief still brings with

it potential for disruption and confusion in a service that thousands of Delawareans depend

on daily. Further, while ESI may be able to show that there were deficiencies in the PBM

procurement process, ESI has failed to show that those deficiencies were material to the

selection process. This decision therefore denies ESI’s motion for summary judgment.

The SEBC and CVS have cross-moved for summary judgment. Those motions are

held in abeyance pending supplemental briefing on the effects of this decision on the

defendants’ motions.

I. FACTUAL BACKGROUND

The facts are drawn from the materials submitted in support of the cross motions for

summary judgment.2 As discussed above, the parties opted to forego additional factual

discovery after the preliminary injunction phase, so the facts before the court now are

nearly the same as they were in June 2021. The only additions to the record are two

declarations explaining efforts undertaken to implement the PBM contract since the

preliminary injunction phase. The first was a supplemental declaration from Faith Rentz,

the Director of the Delaware Statewide Benefits Office (“SBO”), which coordinates the

2 Dkt. 52, Pl.’s Hr’g Ex. List (by “PX”). C.A. No. 2021-0434-KSJM December 13, 2021 Page 4 of 32

procurement of employee benefits on behalf of SEBC.3 The second is the declaration of

Michelle Manolovic, CVS’s Vice President for Business Development, Government and

Labor.4

Although it is true that “factual conclusions reached in a preliminary injunction

proceeding” are “tentative” and “it is open to the court to further consider factual matters

thereafter,”5 because the main part of the factual record is no further developed than it was

at the preliminary injunction hearing, the main part of my factual findings has not changed.

What follows largely tracks the factual background set forth in the PI Ruling.6

Structure of the State Employee Benefits Committee.

The SEBC is a statutorily authorized body comprising elected or appointed officials

or their designees formed to carry out the mission of the State’s Group Health Insurance

Plan (“GHIP”).7

Among its responsibilities, the SEBC selects “all carriers or third-party

administrators necessary to provide coverages to State employees.”8 Relevant to this

3 Dkt. 70, Decl. of Faith L. Rentz, dated Aug. 27, 2021 (“Supp. Rentz Decl.”). 4 Dkt. 72, Decl. of Michelle A. Manolovic, dated Aug. 30, 2021. 5 Braunchsweiger v. Am. Home Shield Corp., 1991 WL 3920, at *1 (Del. Ch. Jan. 7, 1991). 6 See PI Ruling at 3:21–15:10. 7 29 Del. C. § 9602(a). In addition to eight specified elected or appointed officials, the statute requires the Governor to appoint a labor union representative to the SEBC. 8 29 Del. C. § 9602(b)(2). C.A. No. 2021-0434-KSJM December 13, 2021 Page 5 of 32

dispute, the SEBC is responsible for procuring service contracts with PBM providers for

the State’s health insurance program.

PBMs occupy a unique niche in the healthcare ecosystem. Although PBMs’

primary role is to administrate prescription drug programs for health insurance plans,9

PBMs also operate as brokers between payers, drug manufacturers, and pharmacies.10

PBMs earn revenues from client fees for processing claims, rebate savings resulting from

negotiations with drug manufacturers, and “fees and shared savings from the maintenance

of pharmacy networks.”11

When this litigation was filed, ESI was the incumbent PBM for the State’s GHIP.12

The GHIP includes two different population segments: “Commercial,” comprising

approximately 102,000 non-Medicare members, and “Employee Group Waiver Plan” (or

“EGWP”), comprising approximately 27,000 Medicare Part D beneficiaries.13

ESI’s contract for the Commercial segment expired on June 30, 2021.14 Its contract

for the EGWP segment will expire on December 31, 2021.15

9 Cole Werble, Pharmacy Benefit Managers, Health Affairs, Sept. 14, 2017, at 1, https:// www.healthaffairs.org/do/10.1377/hpb20171409.000178/full/healthpolicybrief_178.pdf. 10 Id. 11 Id. 12 Dkt. 44, Decl. of Faith L.

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