Michigan Attorney General Dana Nessel has initiated legal action against two prominent pharmacy benefit managers, Express Scripts, Inc., and Prime Therapeutics LLC. The lawsuit alleges that these entities engaged in practices that limited competition, negatively impacted independent pharmacies, and created pharmacy deserts where access to medication is challenging.
Nessel claims that "the lawsuit contends the two PBMs formed an unlawful agreement that suppressed reimbursement rates to independent pharmacies," which purportedly helped them gain excessive profits and contributed to closures in Michigan and beyond. According to Nessel, these practices force Michigan residents to travel substantial distances to access vital medications, affecting their health and well-being.
"Michigan residents should not have to drive 45 minutes, or sometimes even farther, to pick up the insulin, heart medication, or antibiotics they need," Nessel said. She emphasized the importance of stopping these practices to ensure reliable access to necessary medications.
These pharmacy benefit managers act as intermediaries among insurance companies, drug manufacturers, and pharmacies with a role in controlling costs. The lawsuit specifies that in December 2019, an alleged pact enabled Prime Therapeutics to adopt the lower reimbursement rates of Express Scripts, allowing them access to a broader buying power and network in return for administrative fees. Consequently, independent pharmacies reportedly received less compensation for dispensing medication, sometimes to the point of incurring losses.
The legal complaint suggests these conditions led to the emergence of pharmacy deserts significantly affecting half of Detroit and northern Michigan communities. Nessel argues that these actions are in violation of the Sherman Antitrust Act, Michigan Antitrust Reform Act, and public nuisance laws, and seeks to dissolve the contested agreement among other legal remedies.