Osterhaus Pharmacy Inc v. Express Scripts Inc

District Court, W.D. Washington·Decided February 13, 2025·No. 2:24-cv-00039·Unknown

Opinion

HONORABLE RICHARD A. JONES

UNITED STATES DISTRICT COURT AT SEATTLE

OSTERHAUS PHARMACY, INC., et al., Plaintiffs, Case No. 24-cv-0039-RAJ vs. ORDER EXPRESS SCRIPTS, INC., et al., Defendants. THIS MATTER is before the Court on Defendant Express Scripts, Inc. and Defendant Evernorth Health’s s Motion to Transfer or in the Alternative Dismiss or Strike the Complaint (“Defendants’ Motion”). Dkt. # 77. Plaintiffs oppose transfer and dismissal. Dkt. # 82. Defendants request oral argument, but the Court finds it unnecessary. For the reasons stated below, the Court GRANTS in part and DENIES in part Defendants’ Motion. Dkt. # 77. A. Procedural Background Plaintiffs brought this class action lawsuit in the Western District of Washington against Express Scripts Inc. (“ESI”) and its parent company, Evernorth Health Inc. (collectively, “Defendants”). Dkt. # 1. Plaintiffs filed the First Amended Complaint (“FAC”) in this matter on March 1, 2024. Dkt. # 46. Defendants’ Motion was filed thereafter, and the parties completed the briefing on this motion on July 22, 2024. Plaintiffs filed a Notice of Supplemental Authority on January 24, 2025, Dkt. # 84, and Defendants filed a response, Dkt. # 85, on February 3, 2025.1 B. Factual Background Plaintiffs, a group of pharmacies, challenge agreements that Defendant ESI, a large pharmacy benefit manager (“PBM”), made with each of the alleged Co-Conspirators. The Co-Conspirators are three smaller PBMs, Prime, Benecard, and Magellan. Plaintiffs assert that agreements constitute a horizontal price-fixing scheme in violation of the Shearman Act. The Court summarizes the allegations below. The Complaint states that three PBMs, ESI, CVS Caremark, and OptumRx, control more than 80% of the prescriptions filled in the United States, which means pharmacies must contract with these three PBMs in order to effectively serve their patients. Dkt. # 46 ¶¶ 5–7. Smaller PBMs, such as the Co-Conspirators, have substantially less market share than the three aforementioned PBMs, and have ordinarily and historically offered pharmacies more favorable and competitive reimbursement rates and fees. Id. ¶¶ 10–12.

1 The Court does not reference or rely on this supplemental authority in resolving this motion. Plaintiffs identify three of ESI’s contracts with each Co-Conspirator, as horizontal price-fixing agreements. Plaintiffs allege that each agreememt fixes the Co-Conspirator’s reimbursement rates and fees in accordance with ESI’s rates and fees schedule, effectively “renting” ESI’s market power. See id. ¶¶ 40–70. ESI’s agreements with Co-Conspirators, Prime, Benecard, and Magellan, took effect in 2020, 2022, and 2023, respectively. See id. ¶ 19, 55, 58. The Complaint indicates that the network rental agreements2 only function to set these rates. The only participation by ESI in the process is to add an ESI network identifier to the computer system so that the ESI reimbursement rates and fees will be imposed on the pharmacies and Co-Conspirators’ transactions. See id. ¶ 52–54, 57, 60. Plaintiffs allege ESI and Co-Conspirators operate independently and have not integrated any business functions. See id. ¶ 15, 57, 60. Plaintiffs allege that the network rental agreements “impair free market forces that would otherwise determine [] the prices.” Dkt. # 46 ¶ 62. They allege the agreements have an anticompetitive effect because they result in pharmacies receiving lower reimbursement rate and paying higher transaction fees to the Co-Conspirators than they would without the agreements. See id. Plaintiffs allege that Co-Conspirators and ESI share these supercompetitive profits. See id. ¶¶ 14, 45, 51, 56, 59. Plaintiffs allege that the agreements have the effect of “reducing consumer choice, suppressing the output of pharmacy services, and decreasing the quality of pharmacy services, all without any offsetting procompetitive benefits.” Id. ¶ 62.

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