At the end of 2019, Prime Therapeutics, LLC (“Prime”) announced that it had entered into a three-year supply chain agreement with Express Scripts, Inc. (“ESI”) “to focus on enhancing pharmacy networks and pharmaceutical manufacturer value.” Prime specifically announced that Prime’s health plans would begin to transition to ESI’s commercial and Medicaid pharmacy networks starting April 1, 2020, noting that there would be no change to claims processing requirements, including BIN/PCNs. Prime stated it would continue to operate its claims processing platform and manage and deliver services to its clients and their members, including pharmacy network management, formulary management and clinical programs. ESI similarly commented that Prime would continue to supply full-service pharmacy benefit management offerings for its clients and customers, and stated that it will provide services to Prime related to retail pharmacy network and pharmaceutical manufacturer contracts.
As a result of this joint venture, pharmacies throughout the country in contract with Prime have been facing changes in reimbursement rates as of April 1, 2020. However, these pharmacies have several rights against the effects of the Prime and ESI collaboration, including the reimbursement rate changes. Moreover, this joint venture itself may in fact be in violation of the Prime Pharmacy Participation as an improper assignment.
How Frier Levitt Can Help
Frier Levitt is assisting pharmacies in challenging the effects of the Prime and ESI collaboration, including the reimbursement rate changes. Contact Frier Levitt today to speak to an attorney.