Hollywood-based AIDS Healthcare Foundation has won a $10.3 million arbitration award in a dispute with a pharmacy benefit manager over reimbursement rates for medications for its HIV patients.
The Jan. 17 ruling from Arbitrator Stuart Widman of the American Arbitration Association found that Eagan, Minnesota-based Prime Therapeutics violated Sherman Antitrust Act and Minnesota laws by engaging in price fixing with major pharmacy benefit manager Express Scripts of St. Louis, according to a Jan. 23 release from the foundation.
It said that in addition to the monetary award, Widman issued an injunction against Prime Therapeutics, enjoining the pharmacy benefit manager from engaging in price-fixing discussions with Express Scripts. Furthermore, Widman’s ruling ordered Prime Therapeutics to reimburse the foundation for reimbursement underpayments going back to June of last year.
Pharmacy benefit managers, or PBMs, reimburse pharmacies for much of the difference between what pharmacies pay for the medications and the usually lower copays that patients pay to the pharmacies.
AHF provides care and advocacy services for some 2.2 million HIV patients worldwide, including obtaining and dispensing prescription medications for HIV patients.
In its arbitration claim, it said that since April 2020 Prime Therapeutics had been aligning its pharmacy reimbursement rates with those set by the larger Express Scripts. As such, the two pharmacy benefit managers were no longer competing against each other to offer attractive rates.
“The Prime-ESI ‘collaboration’ has been clearly exposed as per-se-illegal horizontal price-fixing – the cardinal sin of antitrust law and felonious behavior that government antitrust enforcement agencies… should help put a nationwide end to immediately, for all victims,” Jonathan Eisenberg, deputy general counsel-litigation for AHF said in the release.
In a statement, Prime Therapeutics refuted AHF’s argument that pricing harmed patients.
“Prime demonstrated how actual patients saved on prescription drugs as a result of the agreement (between Prime and Express Scripts). With this ruling, AHF is seeking to rewind the clock to cause patients living with HIV/AIDS to pay more – not less – at their pharmacy counter and thereby enrich AHF’s bottom line,” the statement said.
