MHA Long Term Care Network, Inc. v. Express Scripts, Inc.

CourtDistrict Court, E.D. Missouri
DecidedJanuary 10, 2025
Docket4:23-cv-01436
StatusUnknown

This text of MHA Long Term Care Network, Inc. v. Express Scripts, Inc. (MHA Long Term Care Network, Inc. v. Express Scripts, Inc.) is published on Counsel Stack Legal Research, covering District Court, E.D. Missouri primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
MHA Long Term Care Network, Inc. v. Express Scripts, Inc., (E.D. Mo. 2025).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MISSOURI EASTERN DIVISION

MHA LONG TERM CARE ) NETWORK, INC., ) ) Plaintiff, ) ) v. ) Case No. 4:23CV1436 JAR ) EXPRESS SCRIPTS, INC., ) ) Defendant. )

MEMORANDUM AND ORDER This matter is before the Court on Defendant Express Scripts, Inc.’s (“Express Scripts”) motion to dismiss. ECF No. 33. Plaintiff, MHA Long Term Care Network, Inc. (“MHA”), filed its response in opposition, to which Express Scripts filed a reply. The motion is fully briefed and ready for disposition. For the reasons set forth below, Express Scripts’ motion will be granted in part and denied in part. Background and Facts MHA’s Amended Complaint [ECF No. 29] alleges, in pertinent part,1 that it operates as a Pharmacy Services Administrative Organization (“PSAO”). As a PSAO, MHA represents the largest group of long-term care pharmacies in the United States. MHA negotiates contracts with Pharmacy Benefit Managers (“PBMs”) on behalf of pharmacies (the “MHA Membership”) as their contracting agent. As such, MHA has the authority to bind its pharmacies in the MHA Membership to the contracts it negotiates with PBMs and has a right to enforce compliance with

1 Unless otherwise noted, all facts in this section are alleged in MHA’s Amended Complaint and accepted as true for purposes of this motion only. McShane Constr. Co., LLC v. Gotham Ins. Co., the terms and conditions of these contracts and to collect amounts owed to the MHA Membership in circumstances where PBMs fail to make sufficient payments. As a PBM, Express Scripts processes prescription medication claims under patients’ health insurance for different third parties including insurance plan sponsors, which include commercial insurance plans, Medicare plans, and Medicaid plans. Express Scripts essentially

serves as an intermediary between plan sponsors and pharmacies. In 2005, MHA and Express Scripts entered into a Pharmacy Services Agreement (“PSA”), pursuant to which Express Scripts recognized MHA as a PSAO and permitted the MHA Membership to participate in Express Scripts’ Medicare pharmacy networks. Pursuant to the PSA, each of the pharmacies in the MHA Membership is required to enter into a Long-Term Care Agreement with Express Scripts. MHA and Express Scripts have entered into at least two Amendments to the PSA, most recently in 2021 (collectively, the “Contract”). MHA claims that Express Scripts failed to make accurate payments and improperly reconciled prescription drug claims pursuant to the PSA in 2022 and 2023. Further, MHA alleges

that Express Scripts refused to engage in good faith negotiations with MHA as to Express Scripts’ 2024 Medicare Part D reimbursement terms and conditions in violation of the PSA. Finally, MHA states that in 2024, Express Scripts sent solicitations to the MHA Membership directly and without MHA’s prior notice or consent in an effort to circumvent the business and contractual relationship between MHA and its pharmacies in the MHA Membership. Accordingly, MHA filed this action against Express Scripts, alleging breach of contract (Counts I-VI, XI), breach of the implied covenant of good faith and fair dealing (Count VII), tortious interference with contractual and business relationship (Count VIII), violation of the Missouri Uniform Trade Secrets Act (Count IX), violation of the federal Defend Trade Secrets Act (Count X), and seeking declaratory judgment (Count XII). Express Scripts filed the instant motion, pursuant to Federal Rules of Civil Procedure 12(b)(6), requesting that the Court dismiss all Counts of MHA’s Amended Complaint. Legal Standard Federal Rule of Civil Procedure 8(a) requires that a pleading contain “a short and plain statement of the claim showing that the pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2). If a

pleading fails to state a claim upon which relief can be granted, an opposing party may move to dismiss it. See Fed. R. Civ. P. 12(b)(6). The purpose of a Rule 12(b)(6) motion to dismiss for failure to state a claim is to test the legal sufficiency of a complaint to eliminate those actions “which are fatally flawed in their legal premises and deigned to fail, thereby sparing the litigants the burden of unnecessary pretrial and trial activity.” Young v. City of St. Charles, 244 F.3d 623, 627 (8th Cir. 2001). This court “accepts as true the complaint's factual allegations and grants all reasonable inferences to the non-moving party.” Park Irmat Drug Corp. v. Express Scripts Holding Co., 911 F.3d 505, 512 (8th Cir. 2018) (citations omitted). To survive a motion to dismiss, a complaint must contain “enough facts to state a claim

to relief that is plausible on its face.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007). The plaintiff's obligation to provide the grounds of its entitlement to relief “requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do.” Id. at 555. On a motion to dismiss, “a well-pleaded complaint may proceed even if it strikes a savvy judge that actual proof of those facts is improbable, and that a recovery is very remote and unlikely.” Id. at 556 (internal quotation omitted). Rather, a claim is facially plausible when “the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). Discussion At the outset, it should be noted that MHA’s Amended Complaint borders on violating federal pleading standards. Rule 8(a)(2) of the Federal Rules of Civil Procedure requires that a complaint contain “a short and plain statement of the claim showing that the pleader is entitled to relief.” Rule 8(d) requires that “[e]ach allegation must be simple, concise, and direct.” MHA’s Amended Complaint is 72 pages long and contains 283 numbered paragraphs. Further, the Amended Complaint does not begin listing the specific claims until page 53 (paragraph 191).

The content of the Amended Complaint from page 53 to page 71 is just concise and direct enough to avoid violating Rule 8. Cf. Georgeoff v. Barnes, No. 2:09CV00014 ERW, 2009 WL 2757042, at *1 (E.D. Mo. Aug. 26, 2009). Thus, the Court will not dismiss the Amended Complaint on that basis. However, the Court advises MHA to be as succinct as possible in future pleadings. Breach of Contract - Payment and Reconciliation (Counts I and II) The parties do not dispute that Missouri substantive law applies in this case, as the relevant Contract specifies that the parties’ rights and obligations are governed by Missouri law. To prevail on a breach-of-contract claim under Missouri law, the plaintiff must prove “(1) the

existence of a valid contract; (2) the rights and obligations of each party; (3) a breach; and (4) damages.” Kieffer v. Icaza, 376 S.W.3d 653, 657 (Mo. 2012). The existence of a valid Contract between the parties is not disputed, but Express Scripts denies that it breached or failed to perform any obligations under the Contract.

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