Lackie Drug Store, Inc. v. OptumRx, Inc.

CourtCourt of Appeals for the Eighth Circuit
DecidedJuly 16, 2025
Docket24-1231
StatusPublished

This text of Lackie Drug Store, Inc. v. OptumRx, Inc. (Lackie Drug Store, Inc. v. OptumRx, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eighth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lackie Drug Store, Inc. v. OptumRx, Inc., (8th Cir. 2025).

Opinion

United States Court of Appeals For the Eighth Circuit ___________________________

No. 24-1231 ___________________________

Lackie Drug Store, Inc., on behalf of itself and Arkansans similarly situated

Plaintiff - Appellee

v.

OptumRx, Inc.

Defendant - Appellant ____________

Appeal from United States District Court for the Eastern District of Arkansas - Central ____________

Submitted: April 14, 2025 Filed: July 16, 2025 ____________

Before SMITH, SHEPHERD, and KOBES, Circuit Judges. ____________

SHEPHERD, Circuit Judge.

Lackie Drug Store brought this putative class action against several pharmacy benefit managers, including OptumRx. After more than two years of litigation, Lackie amended its complaint, and OptumRx moved to compel arbitration. The district court denied the motion, reasoning that Lackie’s claims were not subject to arbitration. OptumRx appeals, challenging that denial. Having jurisdiction under 9 U.S.C. § 16(a)(1)(B), we affirm in part and reverse in part. I.

OptumRx is a pharmacy benefits manager (PBM), contracting with health insurance plans to manage prescription drug benefits for the plans’ members. Plan members can fill their prescriptions at various pharmacies, and those pharmacies will be reimbursed by the customers’ health plans through OptumRx.

The pharmacies do not contract with OptumRx directly, however; instead, a collective bargaining group serves as a contracting agent on behalf of its member pharmacies. Elevate Provider Network 1 is such an organization which, as relevant here, negotiated and executed an agreement with OptumRx. Thus, Elevate’s member pharmacies could seek reimbursement through OptumRx for prescriptions filled to customers whose health insurance plans contracted with OptumRx.

The agreement between Elevate and OptumRx comprised two documents: the Provider Network Agreement and the Provider Manual. The Network Agreement brings Elevate’s members into OptumRx’s network and, among other things, outlines the general relationship between Elevate and OptumRx and the procedure for member pharmacies to seek reimbursement. Incorporated by reference into the Network Agreement is the second document, the Provider Manual. The Provider Manual, which OptumRx drafted, outlines how pharmacies submit reimbursement claims and how OptumRx would, in turn, fulfill those claims. In particular, the Provider Manual lays out how OptumRx will determine rates at which it will reimburse any claims. Put simply, OptumRx will choose the lowest of four set rates, one of which is OptumRx’s Maximum Allowable Cost (MAC). OptumRx, like other PBMs, maintains a list of its MAC for each generic drug that can be prescribed through its system. This MAC list is proprietary and is not shared with pharmacies except as required by law. Lackie, which operates a pharmacy in Arkansas, believes OptumRx and other PBMs failed to disclose, update, and notify it and other pharmacies of changes to their respective MAC lists in violation of several Arkansas

1 Elevate was formerly known as Good Neighbor Pharmacy Provider Network. -2- statutes. Lackie claims that OptumRx can thus set its rates below the cost of the prescriptions without the pharmacies discovering any under-reimbursement.

So, in November 2020, Lackie sued OptumRx 2 and several other PBMs in Arkansas state court. After the defendants removed the case to federal court, see 28 U.S.C. § 1441, Lackie amended its complaint into a putative class action raising five claims. Count 1 alleged a violation of the Arkansas Deceptive Trade Practices Act, Ark. Code Ann. § 17-92-507; Count 2, a violation of the Trade Practices Act, Ark. Code Ann. § 23-66-201; Count 3, a violation of the Unfair Practices Act, Ark. Code Ann. § 4-75-201; Count 4, civil conspiracy; while Count 5 sought declaratory and injunctive relief, Ark. Code Ann. §§ 16-111-102, 108. Lackie defined its putative class as “[a]ll independent pharmacy business entities that are citizens of Arkansas and that are operating as an independent pharmacy store(s) within the State of Arkansas during past five years . . . .” As part of its requested relief, Lackie alleged the class was entitled to recover the “actual financial losses” from being forced to sell prescriptions while being reimbursed “an amount less than [that] . . . reimburse[d to] a PBM affiliate” pharmacy.

OptumRx sought to dismiss Lackie’s complaint twice over. First, joining with other defendants, OptumRx moved to dismiss Lackie’s complaint for failure to comply with the pleading requirements outlined in Federal Rule of Civil Procedure 8, for failure to exhaust administrative remedies, for failure to state a claim on all five counts, and as partially preempted by Medicare Part D. OptumRx also moved to dismiss under Rule 12(b)(6) separately from the other defendants. According to OptumRx, Lackie failed to comply with certain mandatory pre-dispute procedures from the Network Agreement mandating written notice of any dispute and the opportunity for mediation between the parties. Although OptumRx attached the Network Agreement to its motion, it did not invoke the Provider Manual, which includes an arbitration clause.

2 Lackie also named OptumRx Pharmacy, Inc., an affiliate of OptumRx, as a defendant. Because all claims against the affiliate pharmacy were eventually dismissed, we refer to OptumRx alone. -3- Lackie resisted. On the joint motion to dismiss, Lackie argued against each of the grounds raised by the defendants: its claims complied with Rule 8’s notice- pleading requirements, were not subject to any administrative exhaustion requirement, and were adequately pled with respect to each of the five counts raised, and were not preempted by Medicare Part D. With regard to OptumRx’s independent motion, Lackie argued that OptumRx failed to prove the existence of a valid contract such that Lackie was in fact bound by the Network Agreement.

The district court granted the motions to dismiss in part. Based on the joint motion, the court dismissed Counts 2 and 4 but retained Counts 1, 3, and 5. Furthermore, the district court denied OptumRx’s individual motion. Although it noted that OptumRx’s argument was “well taken,” the district court concluded that there was insufficient evidence of a contract between Lackie and Elevate, so the district court could not say for certain that Lackie was in fact subject to the Network Agreement. Meanwhile, the district court also considered and disposed of each of Lackie’s claims against the other defendants. 3 By the end of the motion-to-dismiss phase, only OptumRx remained as a defendant, faced with only Counts 1, 3, and 5.

OptumRx then filed its answer to Lackie’s complaint. It denied each of Lackie’s remaining claims and, in its list of affirmative defenses, OptumRx alleged that Lackie’s claims were “subject to binding alternative dispute resolution[] procedures.” The district court then issued a final scheduling order for trial, and discovery began. But, believing the district court’s timeline was inadequate, OptumRx and Lackie jointly moved for a nine-month extension, which the district court granted. In January 2023, OptumRx served its initial discovery disclosures before supplementing them roughly a month later. OptumRx also responded to Lackie’s first set of requests for production, producing over a hundred pages of responsive documents. After Lackie served several Rule 30(b)(6) deposition notices, the district court entered a protective order on motion of both parties.

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Lackie Drug Store, Inc. v. OptumRx, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/lackie-drug-store-inc-v-optumrx-inc-ca8-2025.