In December of 2019, Prime Therapeutics LLC (“Prime”) announced a three-year “collaboration” with Express Scripts that was “designed to deliver more affordable care for clients and their members by enhancing pharmacy networks and pharmaceutical value.” According to the companies, Express Scripts will handle pharmacy benefit management services to Prime’s retail network, including negotiation with pharmacies and manufacturers for the pharmacy benefit, while Prime and Express Scripts will independently manage negotiations for the medical benefit and value-based contracting. As a result of this venture, effective April 1, 2020, according to Prime, Prime’s commercial and Medicaid network will be transitioned to Express Scripts’ commercial and Medicaid pharmacy networks. While the impact on patient care remains yet to be seen in the early stages of this collaboration, pharmacies have been left to understand the effect this venture might have on their business.
For example, pharmacies that were previously terminated or denied from Express Scripts’ networks but are active participating providers in Prime’s networks have been invited to reapply for admission so that they can continue to service Prime patients, while also being able to now process for Express Scripts’ patients. However, such pharmacies are required to undergo the application process and become successfully credentialed. That said, pharmacies that were previously terminated or denied from either Prime’s or Express Scripts’ networks find themselves in the uncertain position of whether they can continue servicing their current patients as a result of this collaboration in the event they are not currently active providers in both networks and do not become successfully credentialed.
Further, where pharmacy’s agreements for Prime and Express Scripts might be significantly different, particularly with respect to reimbursement terms, prior to transitioning to Express Scripts or signing any addendum or new agreements, pharmacies should understand the effect on its business.
How Frier Levitt Can Help
If your pharmacy has been previously terminated or denied admission from either Express Scripts’ or Prime’s pharmacy networks, or if your pharmacy is being asked to agree to any new addendums or contract terms, contact Frier Levitt to speak to an attorney today.
