Mission Specialty Pharmacy, LLC v. OptumRx, Inc.

154 F. Supp. 3d 453, 2015 U.S. Dist. LEXIS 173053, 2015 WL 9581866
CourtDistrict Court, W.D. Texas
DecidedDecember 30, 2015
DocketNO. SA-15-CV-885-DAE
StatusPublished
Cited by1 cases

This text of 154 F. Supp. 3d 453 (Mission Specialty Pharmacy, LLC v. OptumRx, Inc.) is published on Counsel Stack Legal Research, covering District Court, W.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mission Specialty Pharmacy, LLC v. OptumRx, Inc., 154 F. Supp. 3d 453, 2015 U.S. Dist. LEXIS 173053, 2015 WL 9581866 (W.D. Tex. 2015).

Opinion

ORDER DENYING MISSION SPECIALTY’S MOTION FOR PRELIMINARY INJUNCTION

David Alan Ezra, Senior United States District Judge

On December 11, 2015, the Court heard oral argument on Mission Specialty Pharmacy’s (“Mission Pharmacy” or “Plaintiff’) Motion for Preliminary Injunction. (Dkt. #8.) Micah Skidmore, Esq., appeared on behalf of Plaintiff; JoAnn Dalrymple, Esq., appeared on behalf of Defendant Op-tumRx, Inc. (“OptumRx” or “Defendant”). After careful consideration of the memo-randa in support of- and in opposition to the motion, and in light of the parties’ arguments at the hearing, the Court, for the reasons that follow, DENIES Plain[456]*456tiffs Motion for Preliminary Injunction. (Dkt. #8).

FACTS

Mission Pharmacy is an independent retail pharmacy in San Antonio which provides both conventional and compounded prescription medications to patients. (“Am. Compl.,” Dkt. #25 ¶ 9; Dkt. #8 ¶¶1-2.) According to Mission Pharmacy, compounded pharmaceuticals are different from conventional prescription medications because they can .be customized to meet specific patients’ needs. (Am, Compl. ¶ 9; “Hall Aft,” Dkt. # 8, Ex. B ¶ 10.) Mission Pharmacy currently offers walk-in prescription services to patients, but also ships compounded medication to patients via Federal Express. (Am. Compl. ¶¶ 10; 17.) Mission Pharmacy states that it complies with applicable licensing requirements in each state where it ships covered prescriptions. (Id. ¶ 17.)

OptumRx is a pharmacy benefit manager. (Am. Compl. ¶ 11; Dkt. # 15 at 2.) On August 29, 2012, OptumRx entered into a Pharmacy Network Agreement (the “Agreement”) with Morris & Dickson Co. LLC d/b/a Community Independent Pharmacy Network (“CIPN”). (Am. Compl. ¶ 12.) Mission Pharmacy joined the CIPN and became party to the Agreement on July 9, 2013. (Id.) The Agreement requires OptumRx to pay Mission Pharmacy for covered .pharmaceuticals it. dispenses to OptumRx patients. (Id. ¶ 13.)

The Agreement between OptumRx and CIPN, to which. Mission Pharmacy became a party in 2013, contains the following provision:

No Mail Fulfillment -or Solicitation. Company and Pharmacy shall not solicit a Member for mail delivery or deliver any Covered Prescription Services to a Member by mail, except upon the advance written approval of Administrator, which approval may be refused in Administrator’s sole discretion.

(Am. Compl. ¶ 14; “Agreement,” Dkt. '# 15, Ex. A-2 § 3-10.) The original Agreement did not define' the' word “mail.” (Am. Compl. ¶ 15.) The 2014 Pharmacy Manual also does not define the word “mail.” (Id. ¶ 18; Dkt. # 8, Ex. C-2.)

The Agreement also contains a provision incorporating the “rules, policies, administrative procedures and guidelines” located in OptumRx’s Pharmacy Manual into the Agreement; this provision notifies Members that these rules “may change from time to time.” (Agreement § 3.15.) The Agreement also contains provisions describing the manner in which the contract or materials incorporated by reference may be modified. (Id. § 11.2.)-One such method allows OptumRx -to unilaterally amend the Agreement and incorporate material if it provides “thirty (30) days prior written notice to Company” before such change. (Id. at § 11.2(b).) The contract modification provision states that “[i]f Company does not object to such amendment in writing within such thirty (30) day notice period, Company and Pharmacy shall be deemed to have accepted the proposed amendment.” (Id.)

OptumRx claims that on December 1, 2014, it published notice via email that its 2015 Pharmacy Manual was available for viewing, and would become effective January 1, 2015. (Dkt. # 15, Ex. A-3.) Mission Pharmacy did not submit written objections to the changes in the Manual. (Dkt. # 8; Dkt. # 15.) The 2015 Pharmacy Manual defines “mail/mailing” as the “action or process of sending Covered Prescription Services through the US mail, shipping via any common carrier (e.g. FedEx, UPS, DHL) or via delivery by any type of courier to Members.” (Am. Compl. ¶ 18; Dkt. #8, Ex. C-3 at 14.) Mission Pharmacy alleges that OptumRx did not obtain Mis[457]*457sion Pharmacy’s consent to add this definition of mail; further, Mission Pharmacy states that OptumRx did not provide any consideration for this change to the manual. (Am. Compl. ¶ 21.)

On June 2, 2015, OptumRx issued a letter to Mission Pharmacy and all other pharmacies contracting through CIPN explaining that OptumRx was terminating the Agreement with CIPN, and inviting Mission Pharmacy and other independent pharmacies “to contract directly with Op-tumRx.” (Am. Compl. ¶ 22; Dkt. #8, Ex. C-4.) Mission Pharmacy’s Amended Complaint challenges the validity of the termination, and seeks a declaration that such termination “violates article 21.52B of the Texas Insurance Code. (Am. Compl. ¶¶ 36, 39(c).)

On August 31, 2015, OptumRx issued a Cease and Desist Letter (the “Letter”) demanding that Mission Pharmacy cease “mailing, shipping, and/or delivering” Covered Prescription Services to members.” (Am. Compl. ¶ 23; Dkt. # 8, Ex. C-5.) The Letter requests that Missión Pharmacy submit written confirmation that it will cease shipping prescriptions, and states that failure to respond' “could result in further disciplinary action, up to and including suspension of payment and termination” from the OptumRx Pharmacy Network. (Am. Compl. ¶ 23; Dkt. #8, Ex. C-5.) Mission Pharmacy continued to ship prescriptions. (Am. Compl. ¶24.) On September 14, 2015, Mission Pharmacy notified OptumRx via letter that OptumRx’s “attempt to limit the-shipment of Covered Prescription Services by Mission through a private carrier service is unenforceable.” (Dkt. # 8, Ex. C-6 at 2.) Further, Mission Pharmacy stated that it would not “agree to cease and desist delivery of Covered Prescription Services by third-party, nongovernmental carriers,” arguing that such delivery “is not prohibited by the Agreement and is necessary to serve the needs of patients.” (Id. at 3.)

On October 22, 2015, OptumRx sent an e-mail to Mission Pharmacy stating that OptumRx would not “take any action to terminate Mission Pharmacy’s status as a participating pharmacy .., on the basis of Mission Pharmacy’s non-participation status or prohibition against mailing before the earlier of December 31, 2015 or when the court rules on the application for preliminary injunction.” (Dkt. #8, Ex. D-2.)

On October 6, 2015, Mission Pharmacy filed suit in the 150th Judicial District Court of Bexar County, Texas seeking a Temporary Restraining Order (Dkt. #1, Ex. A ¶¶ 32-46), as well as Temporary and Permanent Injunctions preventing Op-tumRx from terminating Mission Pharmacy from the pharmacy network for shipping prescriptions through the mail. (Id. ¶¶ 47-49.) On October 14, 2015, OptumRx removed the case to this Court on the basis of diversity. (Id.) On November 2, 2015, Mission Pharmacy filed the instant Motion for Preliminary Injunction. (Dkt. # 8.) On December 10, 2015, Plaintiff filed an amended complaint adding a cause of action for specific performance, which mooted the instant Motion for Preliminary Injunction. (Dkt. #25.) Nonetheless, the parties agreed to conduct the December 11, 2015 preliminary injunction hearing and remedy the procedural issue by filing supplemental responses to the Motion for Preliminary Injunction. (Dkt. #27.) On December 17, 2015, OptumRx filed its Supplemental Response to Plaintiff’s Motion for Preliminary Injunction. "(Dkt. #28.) Mission Pharmacy filed a Response on Dé1 cember 18,2015. (Dkt. # 30.)

LEGAL STANDARD

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

Related

Cite This Page — Counsel Stack

Bluebook (online)
154 F. Supp. 3d 453, 2015 U.S. Dist. LEXIS 173053, 2015 WL 9581866, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mission-specialty-pharmacy-llc-v-optumrx-inc-txwd-2015.