Be On the Lookout For Side-Effects of Changes With Prime Therapeutics and Express Scripts

In December 2019, we learned that Prime Therapeutics, LLC (“Prime”) and Express Scripts sought to begin a massive collaborative effort that would cover over 100 million Americans and was “designed to deliver more affordable care for clients and their members by enhancing pharmacy networks and pharmaceutical value.”  Effective April 1, 2020, Express Scripts began providing its pharmacy benefit management services to Prime’s retail network, including negotiating with pharmacies and manufacturers for the pharmacy benefits that it provides. 

Frier Levitt honed in on the potential impact for pharmacies well over a month ago. However, despite announcing this change in December 2019 and it now having taken effect, Prime and Express Scripts have provided little to no information about how they will treat pharmacies who have a prior existing relationship with either PBM. Among the potential issues facing pharmacy providers, Express Scripts has not stated how it will treat current pharmacies in good standing with Prime who have never participated in Express Scripts’ network, or whether the pharmacy will be required to sign a new contract and undergo recredentialing to gain access to the Express Scripts network. Another potential issue is situations where a pharmacy is in good standing with one PBM but may have previously been terminated from the other prior to this change being implemented. Termination from one network can often serve as the basis for termination from another or as the basis of a credentialing denial, preventing pharmacies from servicing patients in either network.

How Frier Levitt Can Help

These are just a few of the critical issues to be on the lookout for so that your pharmacy is not prevented from providing essential services during these crucial times. If your pharmacy is facing issues related to this significant collaboration between two major PBMs or if your pharmacy has any questions regarding this collaboration, contact Frier Levitt to speak to an attorney today.

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