Park Irmat Drug Corp. v. OptumRx, Inc.

152 F. Supp. 3d 127, 2016 U.S. Dist. LEXIS 3714, 2016 WL 153094
CourtDistrict Court, S.D. New York
DecidedJanuary 12, 2016
Docket15 Civ. 8930 (JSR)
StatusPublished
Cited by25 cases

This text of 152 F. Supp. 3d 127 (Park Irmat Drug Corp. v. OptumRx, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Park Irmat Drug Corp. v. OptumRx, Inc., 152 F. Supp. 3d 127, 2016 U.S. Dist. LEXIS 3714, 2016 WL 153094 (S.D.N.Y. 2016).

Opinion

OPINION ■

JED S. RAKOFF, UNITED STATES DISTRICT JUDGE.

By “bottom-line” order dated December 15, 2015, this Court denied plaintiff s motion for a temporary restraining order and preliminary injunction enjoining defendant from terminating plaintiff from defendant’s retail pharmacy network during the pen-dency of this litigation. This Opinion ex-pláins the reasons for that ruling.

Plaintiff Park Irmat Drug Corp. (“Ir-mat”) is a pharmacy located in midtown Manhattan. Defendant OptumRx, Inc. (“Optum”) is one of the largest Pharmacy Benefit Managers (“PBMs”) in the United States, providing coverage for prescription drugs to over 65 million members. By way of general background on the workings of the industry, PBMs such as Optum are third-party administrators of prescription drug programs, responsible for managing the pharmacy benefits for health plans, negotiating drug discounts with drug manufacturers, developing lists of approved drugs for reimbursement, and processing pharmacies’ and patients’ prescription drug claims. In this capacity, PBMs build networks of pharmacies through which their members can purchase prescription medications at “covered” (i.e., discounted) rates. In order to'gain access to a PBM’s pharmacy network, pharmacies often contract with third-party Pharmacy Services Administrative Organizations '(“PSAOs”) that serve as a single point of contact for the PBMs and negotiate and contract with PBMs on the pharmacies’ behalf.

Optum administers two types of pharmacy networks, a “retail” pharmacy network (which consists of some ■ 65,000 pharmacies) and. a “mail-order” pharmacy network. To participate in Optum’s mail-order network, pharmacies must meet a specialized set of requirements, including being accredited by the Utilization Review Accreditation Commission as a mail service pharmacy, as well as by the National Association of Boards of Pharmacy as a Verified Internet Pharma'cy Practice Site. Optum contends that it requires these accreditations to ensure that mail-order pharmacies have the appropriate controls and prócesses in place to safely dispense medication to patients by mail. Optum also owns and operates its own mail-order pharmacy.

Irmat has been a member of Optum’s pharmacy network since at least.. 2006. Complaint (“Compl”) SI 4, ECF No. 7. In July 2012, however; Irmat entered into an agreement with the PSAO' AecessHealth (the “Irmat/AccessHealth Agreement”) in order to gain.continued access to over 100 third-party payor networks, including Op-tum’s, from which Irmat’s customers receive prescription drug coverage. At that time, AecessHealth had a pharmacy network agreement in place with Optum (the “Prescription Drug Services Agreement”) to which Irmat became subject. The parties appear to agree that the Prescription Drug Services Agreement did not prohibit the provision of - mail-order pharmacy services except with, respect to Medicare Part D patients — to whom Irmat did not provide such services “as a general matter.” Id. ¶ 39.

Beginning in 2011, Irmat began developing a niche practice in dermatology and, over the next several years, expanded this practice by participating in programs sponsored by certain dermatological drug manufacturers, under which such manufacturers would cover some or all of customers’ co-pays. See Affidavit of Victor Falah dated Nov. 12, 2015 (“Falah Ail”) ¶¶ 15-16, ECF No. 17. As a result, Irmat’s business grew substantially and, in 2013, it began filling prescriptions via mail order. [131]*131Irmat’s revenue from Optum members has increased from approximately $2 million in 2012 to a projected $33 million in 2015. See Affidavit of Christopher O’Keefe dated Nov. 12, 2015 (“O’Keefe Aff.”) ¶7, ECF No. 18. At the time of the filing of its motion, mail orders represented r 80% 'of Irmat’s business, see Falah Aff. ¶ 16, and sales- to Optum members accounted for 27% of Irmat’s sales overall, see O’Keefe Aff. ¶5.,

In February 2015; AccessHealth and Optum entered into a new pharmacy network agreement (the “2015 Agreement”), with AccessHealth purporting to act on behalf of its participating pharmacies in its capacity as their agent. See Falah Aff., Ex. 3. Section 3.10 of the 2015 Agreement prohibits such pharmacies from engaging in mail-order fulfillment except upon advance written approval of Optum, and § 5.2.4 of the 2015 Agreement authorizes Optum to “terminate, suspend or revoke any Pharmacy location from participating under this Agreement immediately upon written notice to Company and Pharmacy if . / (v) Pharmacy engages in mail fulfillment in violation of Section 3.10 without Administrator’s written authorization.”

In apparent contravention of its separate agreement with Irmat, AccessHealth never furnished Irmat a written summary of the terms and conditions' of'the 2015 Agreement. See Falah Aff. ¶¶ 19-20. As a result, Irmat contends, it had no knowledge of the terms of the Agreement until it was advised by Optum by letter dated August 10, 2015 that Irmat was filling mail-order prescriptions in violation of the 2015 Agreement. See Falah Aff., Ex. 4; Falah Aff. ¶ 24. Optum requested that Ir-mat confirm within ten business days that it would cease the prohibited activity. In response, by letter dated August 17, 2015, Irmat requested “a 90-day delay in any action by Optum” and argued that it and its patients “would be irreparably harmed if termination occurs.” Id., Ex. 5. On September 16, 2015, Optum advised Irmat via email that while 'Irmat must “remain in compliance with the retail agreement, including the no mail prohibition,” nonetheless, if it wished to avoid termination, it could apply to Optum’s mail-order pharmacy network. Id., Ex. 6. Irmat, in turn, requested that Optum allow it to continue dispensing medication by mail while it applied for the Aecessáry accreditations to join Optum’s mail-order pharmacy network. Id., Ex. 7. By letter dated September 28, 2015, Optum advised Irmat that it would be terminating Irmat for cause, effective November 30,2015. Id., Ex. 8‘.

On November 12, 2015, Irmat filed a complaint against optum in New York State Supreme Court for breach of contract, equitable estoppel, tortious interference with business relations, and antitrust violations under-New York’s Donnelly Act. See Declaration of Michael H- Bernstein dated Nov. 24, 2015 at ¶3, ECF No. 24. On November 13, 2015, Irmat filed the instant motion. Id. ¶¶ 4-5. That same day, Optum filed a notice of removal on diversity grounds pursuant to 28- U,S.C. § 1446 and the action was assigned to this Court. Ultimately, on consent of the parties, the Court issued a scheduling order setting a briefing schedule on plaintiffs motion and staying the termination of Irmat from Op-tum’s pharmacy network until a hearing was held. Order dated Nov. 23, 2015, ECF No. 22. ‘

A court may issue a preliminary injunction and temporary’ restraining order pursuant to Rule 65 of the Federal Rules of Civil Procedure. “[A] preliminary injunction is an extraordinary and drastic remedy, one that should not be granted unless the movant, by, a clear showing, carries the burden of persuasion.” Mazurek v. Armstrong, 520 U.S. 968, 972, 117 S.Ct. 1865, 138 L.Ed.2d 162 (1997) (per [132]*132curiam) (internal quotation mark omitted).

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152 F. Supp. 3d 127, 2016 U.S. Dist. LEXIS 3714, 2016 WL 153094, Counsel Stack Legal Research, https://law.counselstack.com/opinion/park-irmat-drug-corp-v-optumrx-inc-nysd-2016.