Judge tosses nonprofit pharmacy’s antitrust claims against Express Scripts

The AIDS Healthcare Foundation sued pharmacy benefit manager Express Scripts in 2024, claiming it was imposing anticompetitive restraints to kill competition among specialty pharmacies in Louisiana.ST. LOUIS (CN) — A federal judge dismissed the AIDS Healthcare Foundation’s antitrust claims against Express Scripts on Tuesday, finding the pharmacy’s claims are barred because they should have been raised in a previous lawsuit.AHF, which operates a nonprofit pharmacy focusing on HIV/AIDS and hepatitis C patients in Louisiana, sued Express Scripts and its subsidiary, Accredo Health Group Inc., in Missouri federal court in 2024.AHF claimed in the lawsuit that Express Scripts uses its power as a pharmacy benefit manager to create a monopoly in Louisiana for its subsidiary, destroying competition among specialty pharmacies in Louisiana.But U.S. District Judge Maria A. Lanahan found AHF had a chance to bring up the claims against Express Scripts in a prior lawsuit, which was dismissed in February 2023 for failure to state a plausible claim for relief.Lanahan, a Donald Trump appointee, determined “because the prior judgment at issue here was a federal diversity judgment rendered by this court in Missouri *…*Missouri law determines the prior judgment’s claim-preclusive effect.”Lanahan wrote that Missouri prohibits claim splitting, in which a party sues on a claim which arises out of the same act, contract or transaction as the previously litigated claims.“Here, the foundation’s claims are precluded because they arise from the same facts and circumstances as its claims in its prior case against Express Scripts,” Lanahan wrote.She noted AHF’s claims in both cases came out of the same contract — the parties’ 2017 Pharmacy Provider Agreement — and the arguments were similar that Express Scripts has bargaining power and uses it to impose one-sided, arbitrary and opaque contractual terms such as performance incentives, which result in AHF being reimbursed at lower rates.Lanahan also found both lawsuits sought the same remedies: an injunction prohibiting Express Scripts from enforcing the terms of the 2017 Pharmacy Provider Agreement as well as damages.“Given these circumstances, this action is based on the same facts and circumstances as the previous case,” Lanahan wrote.AHF has argued the claims were not precluded because the arguments in the 2024 case involve completely different operative facts, are based on new facts and involve Accredo, which was not a party to the previous lawsuit.Lanahan was unswayed.“This case turns on one central allegation: Express Scripts allegedly ‘engaged in an anticompetitive scheme to leverage its market power as a [pharmacy benefits manager] to unilaterally impose arbitrary and capricious contract terms’ on the Foundation, with those ‘arbitrary and capricious contract terms’ being the ‘low reimbursement rates’ of the 2017 Pharmacy Provider Agreement,” Lanahan wrote. “And that is the same central allegation asserted in Foundation’s prior case too.”“The Foundation’s only excuse for not bringing these claims in the first case is that ‘it was unaware of the basis for’ its contract claims until 2024,” she added. “But the Foundation’s own allegations negate this argument. According to the Foundation, ‘around January 2021, [Express Scripts] drastically cut its reimbursement payments to [the Foundation].’”Neither the lead attorney for AHF nor the lead attorney for Express Scripts immediately responded to a request for comment.Subscribe to our free newslettersOur weekly newsletter Closing Arguments offers the latest about ongoing trials, major litigation and rulings in courthouses around the U.S. and the world, while the monthly Under the Lights dishes the legal dirt from Hollywood, sports, Big Tech and the arts.Additional Reads