Osterhaus Pharmacy Incorporated v. CVS Health Corporation

District Court, D. Arizona·Decided November 14, 2024·No. 2:24-cv-01539·Unknown

Opinion

1 WO 2 3 4 5

9 Osterhaus Pharmacy Incorporated, et al., No. CV-24-01539-PHX-JJT

10 Plaintiffs, ORDER

11 v.

12 CVS Health Corporation, et al.,

13 Defendants. 14 15 At issue are two related motions to compel arbitration (Doc 42; Doc. 68) filed by 16 Defendants against the four named plaintiffs in this class action. The Court finds these 17 matters appropriate for resolution without oral argument. See LRCiv 7.2(f). For the reasons 18 set forth below, the Court denies in part Defendants’ motions and orders supplemental 19 briefing regarding the remainder thereof. 20 I. Background 21 This case concerns alleged anticompetitive conduct in the sector of the pharmacy 22 industry relating to the dispensation of drugs prescribed under Medicare health plans. The 23 motions at issue here do not pertain to the merits of Plaintiffs’ claims, but instead concern 24 the threshold question of whether the claims are subject to mandatory arbitration. The 25 Court therefore offers the following simplified version of the factual allegations 26 underpinning this case. 27 Members of Medicare receive outpatient prescription drug benefits through 28 Medicare Part D. (Doc. 65, First Amended Complaint (FAC) ¶ 42.) “Because Medicare 1 recipients are prescribed more drugs on average than the population as a whole, Medicare 2 beneficiaries constitute an outsized percentage of prescriptions filled in the United States.” 3 (Id. ¶ 44.) Part D benefits are not directly administered by the federal Medicare program. 4 (Id. ¶ 42.) Instead, Part D benefits are administered by a set of private sponsors largely 5 comprised of national health insurance companies, such as Aetna, Cigna, and United. (Id.) 6 These sponsors remit the actual administration of Part D benefits to “pharmacy benefit 7 managers” (PBMs), which the sponsors either contract with or own. (Id. ¶¶ 43, 46.) “PBMs 8 control every facet of the pharmaceutical filling and dispensing industry. They decide 9 which pharmacies can dispense drugs in Part D Plan networks, which drugs those 10 pharmacies will dispense, and the prices, discounts, and other terms of sale applicable to 11 reimbursement of pharmacies.” (Id. ¶ 48.) 12 According to the FAC, the PBM industry has become steadily more horizontally 13 concentrated and vertically integrated over the past several decades. (Id. ¶¶ 49–59.) The 14 field is now dominated by three PBMs, each of which is affiliated with a health insurer that 15 is itself a dominant player in the insurance market. (Id.) Caremark is the largest PBM in 16 the United States. (Id. ¶ 10.) It is affiliated with Aetna, which is one of the largest health 17 insurers in the country. (Id.) The other two major PBMs are OptumRx and Express Scripts, 18 which are affiliated with United and Cigna, respectively. (Id. ¶ 53.) The claims at issue 19 here are against Caremark, Aetna, and their corporate affiliates. Caremark and Aetna are 20 both owned by CVS Health Corporation, which also owns the largest chain of pharmacies 21 in the nation. (Id. ¶ 10.) The level of concentration and integration present in the PBM 22 industry creates enormous opportunity for anticompetitive conduct. (Id. ¶¶ 54–59.) 23 Because Caremark controls access to such a large portion of the country’s Part D 24 beneficiaries, independent pharmacies have no choice but to accept Caremark’s terms of 25 doing business, however unfair or onerous they may be. (Id.) 26 The FAC alleges that Caremark has engaged in monopolistic behavior by way of an 27 anticompetitive fee structure known as “direct and indirect remuneration” (DIR). (Id. 28 ¶¶ 60–70.) Under the applicable Medicare rules and regulations, the drug price presented 1 to the patient at the point of sale must reflect all negotiated price concessions. 2 (Id. ¶¶ 60–63.) However, in 2016, the federal Centers for Medicare and Medicaid Services 3 (CMS) exempted a narrow class of price concessions from the general rule that all such 4 concessions must be determined at the point of sale. (Id. ¶ 65.) The exempted fees are 5 “those contingent price concessions that cannot reasonably be determined at the point-of- 6 sale.” (Id. ¶ 65 (quoting 42 C.F.R. § 423.100 (2016)).) The FAC alleges that Caremark has 7 abused this provision by illegitimately extracting millions of dollars from independent 8 pharmacies. (Id. ¶¶ 66–70.) For example, the FAC claims that “[r]ealizing an opportunity 9 to pilfer money from [independent pharmacies] purportedly under the 2016 CMS changes, 10 CVS Caremark fabricated fees that ‘could not be calculated at the point of sale.’” (Id. ¶ 74.) 11 According to the FAC, Caremark imposes DIR fees in an anticompetitive manner by which 12 Caremark benefits from either (1) extracting substantial fees from independent pharmacies 13 or (2) forcing independent pharmacies out of business, thereby driving customers to CVS 14 Caremark’s own chain of pharmacies. (Id. ¶¶ 70, 93–107, 111.) 15 In order to join Caremark’s network, which the FAC alleges independent 16 pharmacies have no choice but to do, pharmacies must sign a short adhesion contract 17 known as a “provider agreement.” (Id. ¶¶ 108–18.) This provider agreement is subject to 18 unilateral amendment by Caremark on a near limitless basis. (Id.) The provider agreement 19 incorporates numerous documents by reference, most significantly the “provider manual,” 20 which Caremark regularly amends on a unilateral basis. (Id.) The one-sided nature of 21 Caremark’s contractual relations with independent pharmacies effectively grants Caremark 22 sole discretion to shape the parties’ relationship to its liking, including by imposing 23 anticompetitive DIR fees that independent pharmacies lack the leverage to object to. (Id.) 24 According to the FAC, Caremark’s contractual terms violate numerous state and federal 25 laws governing the provision of pharmacy services. (Id. ¶¶ 119–24.) “CVS Caremark seeks 26 to shield its unlawful conduct from being challenged by including in its contracts with 27 Independent Pharmacies a forced arbitration clause with several unconscionable terms.” 28 (Id. ¶ 125.) It is this arbitration provision that forms the crux of the instant motions. 1 Plaintiffs are four independent pharmacies, with “independent” defined as “not part 2 of the same corporate family as any of the three largest” PBMs. (Id. ¶¶ 9, 52.) Defendants 3 are eleven entities, all of which exist within the CVS/Caremark/Aetna corporate umbrella. 4 Plaintiffs have brought suit on behalf of themselves and on behalf of “[a]ll Pharmacy 5 Services Providers in the United States that are not members of the same corporate family 6 as a Big Three PBM and that have paid DIR fees directly to CVS Caremark from 7 September 26, 2019 until the time of trial.” (Id. ¶ 127.) The FAC asserts the following 8 seven federal and state claims: (1) violation of the Sherman Antitrust Act, (2) breach of 9 contract, (3) breach of the implied covenant of good faith and fair dealing, (4) declaratory 10 judgment of unconscionability, (5) declaratory judgement of illegality based on violation 11 of Medicare regulations, (6) unjust enrichment, and (7) quantum meruit. (Id. ¶ 138–71.) 12 Plaintiff Osterhaus Pharmacy initiated this action in September 2023 in the Western 13 District of Washington. (Doc. 1.) On June 18, 2024, the federal court in Washington 14 transferred this case sua sponte to the District of Arizona. (Doc. 53.) Prior to the transfer 15 of venue, Defendants filed a Motion to Compel Arbitration (Doc. 42), to which Osterhaus 16 Pharmacy filed a Response (Doc. 44) and Defendants filed a Reply (Doc. 48). Following 17 the transfer of venue, three additional plaintiffs joined this action. Shortly thereafter, 18 Defendants filed a Motion to Compel Arbitration Against Newly Named Plaintiffs 19 (Doc. 68), to which Plaintiffs filed a Response (Doc.

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

Osterhaus Pharmacy Incorporated v. CVS Health Corporation, (D. Ariz. 2024).

Osterhaus Pharmacy Incorporated v. CVS Health Corporation (Osterhaus Pharmacy Incorporated v. CVS Health Corporation) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Pokorny v. Quixtar, Inc.
601 F.3d 987 (Ninth Circuit, 2010)
At&T Technologies, Inc. v. Communications Workers
475 U.S. 643 (Supreme Court, 1986)
United States v. James C. Dunkel
927 F.2d 955 (Seventh Circuit, 1991)
In the Matter of Rachel R. Alexander
300 P.3d 536 (Arizona Supreme Court, 2013)
Maxwell v. Fidelity Financial Services, Inc.
907 P.2d 51 (Arizona Supreme Court, 1995)
Bill Hansen v. Lmb Mortgage Services, Inc.
1 F.4th 667 (Ninth Circuit, 2021)
Concetta Rizzio v. Surpass Senior Living LLC
492 P.3d 1031 (Arizona Supreme Court, 2021)
Pusch v. Brady
53 P. 176 (Arizona Supreme Court, 1898)
Dueñas v. Life Care Centers of America, Inc.
336 P.3d 763 (Court of Appeals of Arizona, 2014)
McDonnell v. United States
4 F.3d 1227 (Third Circuit, 1993)
Caremark, LLC v. Chickasaw Nation
43 F.4th 1021 (Ninth Circuit, 2022)
Kenneth Holley-Gallegly v. Ta Operating, LLC
74 F.4th 997 (Ninth Circuit, 2023)
Abraham Bielski v. Coinbase, Inc.
87 F.4th 1003 (Ninth Circuit, 2023)