GoodRx and CVS Sued for Suppressing Pharmacy Reimbursement

Smaller pharmacies are accusing GoodRx and CVS of colluding to suppress generic prescription drug reimbursements.

As Reuters reported Tuesday (Nov. 5), drug coupon aggregator GoodRx and a pair of pharmacy benefit managers (PBMs) — CVS’s Caremark unit and Express Scripts — have all been named in at least three lawsuits by independent pharmacies.

PBMs, the report notes, negotiate the cost of prescription drugs between insurance companies, pharmacies and drugmakers, directly reimbursing pharmacies according to the terms of their negotiated plans.

In addition, they offer discount cards consumers can use at their pharmacy networks. These cards have typically been used by uninsured consumers to pay for medications out of pocket.

The lawsuits say that until recently, patients could use a discount card rather than their insurance plan if it offered a lower price, but the payment would not go toward their deductible.

According to the suits, the PBMs — the largest in the country — and GoodRx last year agreed to use GoodRx’s software to compare all available discounts for all patients’ generic drug prescriptions, and route purchases through the PBM with the cheapest price — even if it was different than the patient’s PBM.

“CVS Caremark generally reimburses independent pharmacies at higher levels than chain drugstores, including CVS pharmacies,” CVS Caremark spokesperson Mike DeAngelis told Reuters. “These lawsuits are entirely without merit, and we will vigorously defend against them.”

PYMNTS has contacted GoodRx for comment but has not yet gotten a reply.

Reached by PYMNTS, a spokesperson for Cigna-owned Express Scripts said: “The premise of these lawsuits is categorically false. Our partnership with GoodRx helps promote lower prices for patients at the pharmacy counter by directly integrating discount card pricing with customers’ pharmacy benefits. This program is an important part of our work to protect customers from high drug costs, particularly for customers with high deductible plans.”

The suit comes amid significant pushback by regulators and lawmakers against PBMs. As noted here last year, while there are dozens of such companies in the U.S., just three — CVS Caremark, Express Scripts and Optum Rx — control the bulk of the market.

Last month, U.S. Senators Sherrod Brown (D-Ohio) and Ron Wyden (D-Ore.) urged the Federal Trade Commission (FTC) to open an investigation into the co-manufacturing agreements of PBMs and their parent companies.

“The concern with these co-manufacturing agreements is that they are a veiled attempt by PBMs to control additional parts of the supply chain,” the senators wrote in a letter to the FTC. The result, they argue, is fewer drug choices for patients and higher costs. CVS disputes this claim, arguing that their agreements have saved clients $500 million on immunosuppressive drugs such as Humira.

And last year, the New York Department of Financial Services (NYDFS) announced proposed regulations governing the conduct of PBMs operating in the state.

“These regulations establish strong protections for consumers and small businesses, including prohibiting abusive contract terms that raise drug costs for consumers and strain small pharmacies, as well as establish network adequacy standards to ensure consumers have access to affordable prescriptions where they live,” the NYDFS said in a news release.