Express Scripts, Inc., V State Of Wa Dept. Of Revenue

CourtCourt of Appeals of Washington
DecidedMarch 26, 2019
Docket50348-4
StatusPublished

This text of Express Scripts, Inc., V State Of Wa Dept. Of Revenue (Express Scripts, Inc., V State Of Wa Dept. Of Revenue) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington 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 State Of Wa Dept. Of Revenue, (Wash. Ct. App. 2019).

Opinion

Filed Washington State Court of Appeals Division Two

March 26, 2019

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

DIVISION II EXPRESS SCRIPTS, INC., No. 50348-4-II

Appellant,

v.

STATE OF WASHINGTON, PUBLISHED OPINION DEPARTMENT OF REVENUE,

Respondent.

SUTTON, J. — Express Scripts Inc. (ESI), a pharmacy benefit management company

(PBM), appeals the superior court’s order granting summary judgment in favor of the Department

of Revenue. ESI argues that it should not be subject to Washington’s business and occupation

(B&O) tax1 for payments it receives from clients for the value of prescription drugs because that

value qualifies as “pass-through” funds. In the published portion of this opinion, we hold that the

portion of payments ESI receives from its clients representing the value of the prescription drugs

does not qualify as “pass-through” funds and is subject to the B&O tax.

In the unpublished portion of this opinion, we reject ESI’s remaining arguments.

Accordingly, we affirm.

1 Ch. 82.04 RCW. No. 50348-4-II

FACTS

I. EXPRESS SCRIPTS

ESI is a PBM company headquartered in Missouri. ESI’s clients include health

maintenance organizations, health insurers, third-party administrators, employers, union-

sponsored benefit plans, and government health programs. These clients hire ESI, in relevant part,

to manage the clients’ prescription drug benefit programs. ESI’s services include pharmacy

network management, claims processing, mail order and specialty mail order pharmaceuticals

through ESI affiliates, formulary development, and rebate management.

ESI negotiates with pharmaceutical manufacturers to obtain rebates and other payments to

ESI based on utilization of the pharmaceutical manufacturers’ products by ESI’s clients’ members.

Those rebates and fees are negotiated and set forth in contracts independently negotiated and

entered into between ESI and the pharmaceutical manufacturers. Pursuant to separate contracts

between ESI and its clients, ESI generally pays a portion of the rebates it receives to the clients,

and may also guarantee a minimum rebate per prescription dispensed to the clients’ members. The

rebate portion that the clients receive varies according to each client’s contract with ESI.

ESI contracts with independent third-party retail pharmacies to provide prescription drugs

to ESI’s clients’ members. ESI negotiates with the pharmacies to determine the price at which the

pharmacies will provide prescription drugs to the members. When a member presents his or her

identification card at a network pharmacy, the network pharmacist sends the specified member

and prescription information through ESI’s systems which process the claim and respond back to

the pharmacy. ESI confirms the member’s eligibility for benefits and the conditions or limitations

of coverage. If a member’s claim is accepted, ESI confirms to the pharmacy that it will receive

2 No. 50348-4-II

payment for the drug dispensed according to the agreement entered into between ESI and the

pharmacy.

Periodically, ESI invoices its clients. These invoices include amounts related to the

prescription drugs provided by the pharmacies to the clients’ members, and administrative and

dispensing fees due under the clients’ contracts with ESI.

II. DEPARTMENT’S AUDITS OF ESI

In 2007, the Department audited ESI’s corporate subsidiary ESI Mail Pharmacy, Inc. for

the period of January 2001 through December 2006. The resulting audit report stated:

Express Scripts also receives a dispensing fee for the costs of providing the pharmacy benefit service. WAC 458-20-194 explains the application of various business and occupation taxes to persons doing business inside and outside of Washington State. Tax is not due upon any part of the gross income received for services incidentally rendered to persons in Washington by a person who is not domiciled or does not maintain a place of business in Washington. Because Express Scripts does not have physical presence in the state and all of the activities associated with this fee occur outside of Washington, none of this fee would be subject to the B&O tax.

Clerk’s Papers (CP) at 619-20.

Several years later, in 2011, the Department audited ESI for the tax period of January 1,

2007 through December 31, 2010. As a result of the audit, the Department issued a tax assessment

of $11,794,092.00 plus interest and penalties for a total obligation of $14,190,659.00.

ESI paid the assessed amount and sued for a refund under RCW 82.32.180. ESI also sought

to invalidate a Department administrative rule, former WAC 458-20-194 (2006) (Rule 194 (2006))

under the Administrative Procedure Act (APA).2 The superior court addressed ESI’s claims in

2 Ch. 34.05 RCW.

3 No. 50348-4-II

two phases: a rule challenge under the APA and a tax refund action under RCW 82.32.180. See

CP at 303.

III. PROCEDURAL FACTS

On January 23, 2017, the Department moved for summary judgment of all of ESI’s claims.

Two days later, the Department moved for partial summary judgment on the issue of whether ESI

had a physical presence in Washington during the audit period, such that it was subject to the B&O

tax. The superior court granted the Department’s motion for partial summary judgment on the

issue of physical presence on March 10.

On March 24, the superior court entered an order granting the Department’s motion for

summary judgment on all remaining issues except “the ‘pass-through’ issue.” CP at 949. The

superior court ruled that it would take the pass-through issue under advisement and consider

additional briefing on the issue. After reviewing supplemental briefing from both parties, the

superior court entered an order granting the Department’s motion for summary judgment in its

entirety on April 14, 2017.

ESI appeals.

ANALYSIS

I. “PASS-THROUGH” FUNDS

ESI argues that the superior court erred by granting the Department’s motion for summary

judgment because payments from its clients for the value of the prescription drugs, or

“ingredients,” should be exempted from the B&O tax assessment because those amounts are

merely “pass-through” funds moving from its clients, through ESI, to the pharmacies. Br. of

Appellant 25-26. The Department disagrees and argues that because ESI takes on the obligation

4 No. 50348-4-II

to pay retail pharmacies for the prescription drugs as part of its business model, and ESI

independently negotiates payment of and recuperation for the value of the prescription drugs with

both the retail pharmacies and ESI’s clients, it is subject to the B&O tax on the money it receives

from its clients. We agree with the Department.

We review summary judgment orders de novo, performing the same inquiry as the superior

court. Washington Imaging Servs., LLC v. Dep’t of Revenue, 171 Wn.2d 548, 555, 252 P.3d 885

(2011). Summary judgment is appropriate if there are no genuine issues of material fact and the

moving party is entitled to judgment as a matter of law. CR 56(c).

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

Related

Rho Company v. Department of Revenue
782 P.2d 986 (Washington Supreme Court, 1989)
Kramarevcky v. Department of Social & Health Services
863 P.2d 535 (Washington Supreme Court, 1993)
Smith v. State
391 P.2d 718 (Washington Supreme Court, 1964)
Colonial Imports, Inc. v. Carlton Northwest, Inc.
853 P.2d 913 (Washington Supreme Court, 1993)
Walthew v. Department of Revenue
691 P.2d 559 (Washington Supreme Court, 1984)
Imaging Services v. State Dept. of Revenue
252 P.3d 885 (Washington Supreme Court, 2011)
First American Title Insurance v. Department of Revenue
27 P.3d 604 (Washington Supreme Court, 2001)
City of Tacoma v. William Rogers Co.
60 P.3d 79 (Washington Supreme Court, 2002)
Washington Imaging Services, LLC v. Department of Revenue
171 Wash. 2d 548 (Washington Supreme Court, 2011)

Cite This Page — Counsel Stack

Bluebook (online)
Express Scripts, Inc., V State Of Wa Dept. Of Revenue, Counsel Stack Legal Research, https://law.counselstack.com/opinion/express-scripts-inc-v-state-of-wa-dept-of-revenue-washctapp-2019.