Two small pharmacies sued a pharmacy benefits manager for antitrust violations, alleging that the benefits manager had conspired with Walgreens to drive the small pharmacies from the benefits manager’s network and therefore harm their business. The district court ruled in favor of the benefits manager. After appealing, the 7th Circuit found that the pharmacies had not alleged that either the benefits manager or Walgreens had monopoly power in the relevant markets as required under Section 2 of the Sherman Act, and it, therefore, affirmed the decision of the district court.
Prime Therapeutics LLC is a pharmacy benefits manager. Sharif Pharmacy, Inc. and J&S Community Pharmacy, Inc. were both members of the Prime pharmacy network. Under Medicare, Medicaid, and private health insurance plans, patients had significant financial incentives to buy their prescription drugs from pharmacies within the network. Prime eventually terminated both Sharif and J&S from the network after audits uncovered irregularities in invoicing for prescription drugs.
Both Sharif and J&S filed suits against Prime, alleging violations of the Sherman Antitrust Act. Three customers who had to temporarily move their prescriptions to less convenient pharmacies also joined the suits. Both Sharif and J&S alleged that Prime’s decision to audit their pharmacies was pretextual, in an effort to eject competing pharmacies from the network after Prime entered into a joint venture with Walgreens in 2016. Sharif and J&S noted that Prime sent letters to both pharmacies’ customers saying that Sharif and J&S would no longer accept their insurance and recommending that customers have their prescriptions filled at a nearby Walgreens. Prime also retained funds from both pharmacies as a result of the audits. The district courts both ruled in favor of Prime, and Sharif and J&S appealed. The 7th Circuit consolidated then consolidated the appeals. Continue reading ›