Sausalito Pharmacy v. Blue Shield of California

544 F. Supp. 230, 1981 U.S. Dist. LEXIS 11270
District Court, N.D. California·Decided March 16, 1981·No. C-78-2196 RFP·Published·Cited by 24 cases

Opinion

MEMORANDUM AND ORDER

PECKHAM, Chief Judge.

Defendants in this antitrust action have moved this court for summary judgment on the issue of their liability under Section 1 of the Sherman Act and the corresponding section of the Cartwright Act. This court, having heard oral argument on the motion on December 22, 1980 and having fully con *232 sidered all matters herein, decides to grant the motion with respect to all defendants in the action. In addition, defendant Blue Shield renewed its motion for summary judgment on the grounds that its agreements are exempt from the antitrust laws under the state action exemption set forth in Parker v. Brown, 317 U.S. 341, 63 S.Ct. 307, 87 L.Ed. 315 (1943). As we grant the motion for summary judgment on the merits, we do not reach a decision on Blue Shield’s claim of state action immunity.

I. BACKGROUND

A. Factual

Plaintiffs in this antitrust action are challenging the legality of prepaid prescription drug plans administered or underwritten by the defendants. The plaintiffs are independent retail pharmacies which participate in defendants’ prepaid drug plans.

The defendants — insurance companies and plan administrator companies — maintain two separate agreements for each plan. The first agreement is between the insurance company and the insured. Although the terms vary from plan to plan, generally they provide that the insured will pay a certain deductible (or copayment) of the cost of prescription drugs and the insurer will pay the rest. The amount of the deductible varies among the defendants and among the plans maintained by each defendant as well. In order to receive the benefit of the agreement, the insured must purchase from a pharmacy which participates in the prepaid plan with the insurance company. If the insured chooses to purchase his drugs elsewhere, he must pay the entire purchase price; he is, however, generally entitled to reimbursement from the insurer. The amount of reimbursement differs from plan to plan.

The second agreement is between the pharmacy and the insurer (or the pharmacy and the plan administrator if the insurance company does not administer its own plan). Each agreement contains three price components. The first, the deductible or copayment, is collected by the pharmacy from the insured. Under the pharmacy agreement, the pharmacy may not charge the insured any more than this amount. The second component — the ingredient cost — is determined by market constraints and generally equals or exceeds the participating pharmacies’ actual acquisition cost for the prescription drug from its suppliers. This amount is paid directly to the pharmacy by either the administrator or insurer. The final price component, the dispensing fee, in effect, attempts to reflect a reasonable profit for the pharmacy. This amount also varies from plan to plan and is determined by market constraints.

The pharmacy agreements are prepared by the insurance companies and are presented to the pharmacies on a take-it-or-leave-it basis; the member pharmacies and the insurance companies do not negotiate the terms of the contract. The pharmacies are free, however, to choose among the various existing plans offered by the different insurance companies. Some insurance companies do not administer their own plans; in that case, the administrator deals directly with the pharmacy. The terms of the plan and the amounts of the price components, however, are in all cases set by the insurance companies.

B. Procedural

In October of 1979, plaintiffs moved for summary judgment on the grounds that the pharmacy agreements were per se violative of Section 1 of the Sherman Act. We deferred ruling until a decision was issued in Group Life & Health Insurance Co. v. Royal Drug, 440 U.S. 205, 99 S.Ct. 1067, 59 L.Ed.2d 261 (1979) in which the Court considered whether substantially similar insurer pharmacy agreements were Within the “business of insurance” exception to the Sherman Act and therefore exempt from scrutiny. Holding that such agreements were not within the “business of insurance” exception, the Court characterized these agreements as “arrangements for the purchase of goods and services by [the insurer].” 440 U.S. at 214, 99 S.Ct. at 1075. Relying on this characterization, we denied plaintiffs’ motion for summary judgment, *233 holding that contracts between a purchaser [insurance company] and seller [pharmacy] are not the sort of price fixing agreements that are per se illegal under the Sherman Act. We further held that such agreements were to be scrutinized under the rule of reason standard.

In the same order, we considered defendant Blue Shield’s motion for summary judgment on the grounds of state action immunity. In denying this motion, we held that the second criteria in establishing immunity — the policy must be actively supervised by the state itself — was not sufficiently established. Blue Shield again moves for summary judgment on the ground of immunity by virtue of state supervision.

Plaintiffs, in their complaint, alleged several antitrust violations. They are proceeding now, however, only with respect to their claims under Section 1 of the Sherman Act (and corresponding sections of the Cartwright Act). Plaintiffs allege both vertical and horizontal violations.

II. DISCUSSION

A. Introduction

Section 1 of the Sherman Act provides, in relevant part:

Every contract, combination in the form of trust or otherwise, or conspiracy, in restraint of trade or commerce among the several States, or with foreign nations, is declared to be illegal.

Defendants contend that the pharmacy agreements at issue are per se legal under the act. While this characterization may be somewhat inaccurate as all contracts are tested under the rule of reason for the extent, of their anticompetitive effect and are therefore not per se legal, we assume that defendants mean that, as a matter of law, these contracts do not amount to unreasonable restraints of trade.

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Sausalito Pharmacy v. Blue Shield of California, 544 F. Supp. 230, 1981 U.S. Dist. LEXIS 11270 (N.D. Cal. 1981).

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