Waterfront Family Pharmacy LLC v. OptumRX, Inc., Express Scripts, Inc., and Caremark PHC, LLC d/b/a CVS Caremark

CourtDistrict Court, N.D. West Virginia
DecidedMarch 31, 2026
Docket1:25-cv-00029
StatusUnknown

This text of Waterfront Family Pharmacy LLC v. OptumRX, Inc., Express Scripts, Inc., and Caremark PHC, LLC d/b/a CVS Caremark (Waterfront Family Pharmacy LLC v. OptumRX, Inc., Express Scripts, Inc., and Caremark PHC, LLC d/b/a CVS Caremark) is published on Counsel Stack Legal Research, covering District Court, N.D. West Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Waterfront Family Pharmacy LLC v. OptumRX, Inc., Express Scripts, Inc., and Caremark PHC, LLC d/b/a CVS Caremark, (N.D.W. Va. 2026).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF WEST VIRGINIA

WATERFRONT FAMILY PHARMACY LLC,

Plaintiff,

v. CIVIL NO. 1:25-CV-29 (KLEEH) OPTUMRX, INC., EXPRESS SCRIPTS, INC., and CAREMARK PHC, LLC d/b/a CVS Caremark,

Defendants.

MEMORANDUM OPINION AND ORDER GRANTING MOTIONS TO COMPEL ARBITRATION, GRANTING MOTION TO SEVER AND TRANSFER, AND DISMISSING CASE

Pending before the Court are several motions. For the reasons discussed below, the Court GRANTS the motions to compel arbitration, GRANTS the motion to sever and transfer, and DISMISSES this action. I. BACKGROUND AND PROCEDURAL HISTORY The Plaintiff, Waterfront Family Pharmacy LLC (“Waterfront”), brought this action against the Defendants, Optumrx, Inc. (“Optumrx”), Express Scripts, Inc. (“Express Scripts”), Caremark PHC, LLC d/b/a CVS Caremark (“Caremark”), and Humana Pharmacy Solutions, Inc. (“Humana”) (together, “Defendants”). Humana was dismissed from the case on May 13, 2025. Waterfront alleges that Defendants violated the West Virginia Pharmacy Audit Integrity Act (the “Act”), W. Va. Code § 33-51- MEMORANDUM OPINION AND ORDER GRANTING MOTIONS TO COMPEL ARBITRATION, GRANTING MOTION TO SEVER AND TRANSFER, AND DISMISSING CASE

9(f). Defendants are pharmacy benefits managers (“PBMs”). Waterfront alleges that Defendants refused to reimburse Waterfront at the required rate, fraudulently concealed their actions, and entered into unconscionable arbitration and choice-of-law provisions to avoid complying with the Act. On March 31, 2025, Waterfront filed a complaint. See ECF No. 1. On June 4, 2025, it filed an amended complaint to substitute and name the correct Caremark entities. See ECF No. 76. The following motions are pending and fully briefed: (1) Waterfront’s motion for preliminary injunction [ECF No. 31];

(2) Caremark’s motion to compel arbitration [ECF No. 39];

(3) Optumrx’s motion to compel arbitration [ECF No. 45];

(4) Express Scripts’s motion to dismiss [ECF No. 50];

(5) Express Scripts’s motion to sever and transfer claims or, in the alternative, to dismiss [ECF No. 80];

(6) Optumrx’s renewed motion to compel arbitration [ECF No. 89]; and

(7) Caremark’s renewed motion to compel arbitration [ECF No. 90]. MEMORANDUM OPINION AND ORDER GRANTING MOTIONS TO COMPEL ARBITRATION, GRANTING MOTION TO SEVER AND TRANSFER, AND DISMISSING CASE

II. ALLEGATIONS IN THE AMENDED COMPLAINT The Act became effective on June 4, 2018. Am. Compl., ECF No. 76, at ¶ 8. It regulates the conduct of PBMs and has been amended from time to time. Id. ¶ 9. In 2021, the West Virginia Legislature (the “Legislature”) passed an amendment to the Act, codified at W. Va. Code § 33-51-9(f). Id. ¶ 10. The amendment makes it illegal for a PBM to “reimburse a pharmacy or pharmacist for a prescription drug or pharmacy service in an amount less than the amount the [PBM] reimburses itself or an affiliate for the same prescription drug or pharmacy service.” Id. ¶ 11. Waterfront alleges that since 2021, Defendants have “intentionally, willfully, systematically, and with fraudulent intent engaged in an illegal scheme” to violate the Act “by reimbursing their own affiliated pharmacies for prescription drugs and pharmacy services at rates much higher than the rates at which they have reimbursed . . . [Waterfront] for the same prescription drugs and pharmacy services.” Id. ¶ 12. Waterfront alleges that Defendants have acted to cover up and fraudulently conceal their illegal activities. Id. ¶ 14. Waterfront alleges that the Act requires Defendants to post on their websites significant quarterly reporting of their activities, and since 2021, Defendants have refused to do so in an WATERFRONT V. OPTUMRX ET AL. 1:25-CV-29 MEMORANDUM OPINION AND ORDER GRANTING MOTIONS TO COMPEL ARBITRATION, GRANTING MOTION TO SEVER AND TRANSFER, AND DISMISSING CASE effort to hide unlawful activity. Id. FI 15-17. Waterfront also alleges that Defendants have each imposed unconscionable adhesive contracts, which they have utilized to violate the Act and conceal violations from Waterfront. Id. 47 18. Waterfront further alleges that Defendants have refused to make copies of the contracts available to Waterfront, and the purpose of this was to fraudulently conceal their illegal scheme. Id. @@ 19-20. The adhesive contracts, as Waterfront alleges, contain “broad and onerous choice of law provision and arbitration clauses,” which force Waterfront to adjudicate disputes under non-West Virginia law and participate in arbitration in another state. Id. @ 21. Waterfront brings the following causes of action: e® Count One: Violation of the Act, W. Va. Code § 33-51-9(f) (against all Defendants); and e Count Two: Declaratory Judgment, 28 U.S.C. § 2201 (against all Defendants). Waterfront requests the following relief: e Injunctive relief enjoining Defendants from continually and prospectively violating the Act by entering an order requiring Defendants to comply with the Act in its entirety; e Injunctive relief ordering Defendants to adhere to the requirements of the Act by publishing their required reports on _ the publicly available websites for a period of at least 24 months;

WATERFRONT V. OPTUMRX ET AL. 1:25-CV-29 MEMORANDUM OPINION AND ORDER GRANTING MOTIONS TO COMPEL ARBITRATION, GRANTING MOTION TO SEVER AND TRANSFER, AND DISMISSING CASE

e Declaratory relief; e Compensatory damages; e Punitive damages; e Pre-judgment and post-judgment interest; e Attorney’s fees costs, and expenses; and e Any other relief deemed appropriate by the Court.

III. STANDARD OF REVIEW Rule 12 (b) (1) Rule 12(b) (1) of the Federal Rules of Civil Procedure allows the Court to dismiss an action for lack of jurisdiction over the subject matter. “The plaintiff bears the burden of proving that subject matter jurisdiction exists.” Evans v. B.F. Perkins Co., 166 F.3d 642, 647 (4th Cir. 1999) (citation omitted). In considering a motion to dismiss pursuant to Rule 12(b) (1), the court should “regard the pleadings as mere evidence on the issue, and may consider evidence outside the pleadings without converting the proceeding to one for summary judgment.” Id. (citation omitted). The court should grant the motion “only if the material jurisdictional facts are not in dispute and the moving party is entitled to prevail as a matter of law.” Id. (citation omitted). When a defendant asserts multiple defenses, “questions of subject

MEMORANDUM OPINION AND ORDER GRANTING MOTIONS TO COMPEL ARBITRATION, GRANTING MOTION TO SEVER AND TRANSFER, AND DISMISSING CASE

matter jurisdiction must be decided first, because they concern the court’s very power to hear the case.” Owens-Illinois, Inc. v. Meade, 186 F.3d 435, 442 n.4 (4th Cir. 1999) (citations and internal quotation marks omitted). Rule 12(b)(6) Rule 12(b)(6) of the Federal Rules of Civil Procedure allows a defendant to move for dismissal upon the ground that a complaint does not “state a claim upon which relief can be granted.” In ruling on a 12(b)(6) motion to dismiss, a court “must accept as true all of the factual allegations contained in the complaint.” Anderson v. Sara Lee Corp., 508 F.3d 181, 188 (4th Cir. 2007) (citations omitted). A court is “not bound to accept as true a legal conclusion couched as a factual allegation.” Papasan v.

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Bluebook (online)
Waterfront Family Pharmacy LLC v. OptumRX, Inc., Express Scripts, Inc., and Caremark PHC, LLC d/b/a CVS Caremark, Counsel Stack Legal Research, https://law.counselstack.com/opinion/waterfront-family-pharmacy-llc-v-optumrx-inc-express-scripts-inc-and-wvnd-2026.