Antitrust Tools Available to Combat PBM Abuse of Pharmacies

Frier Levitt works with pharmacies, providers, and life science entities to prevent Pharmacy Benefit Managers (PBMs) from unlawfully driving prescription volume to PBM-owned pharmacies, from abusive and below cost reimbursement rates, and otherwise preventing PBMs from using market dominance in an abusive manner, to the detriment of providers. Antitrust and Competition law, combined with state and federal Any Willing Provider laws, provide pharmacies multiple options to fight against a broad range of anti-competitive tactics, including:

  • Network Exclusionary practices
  • Tying and bundling of services or products, for example, wherein a PBM-owned Specialty Pharmacy would demand access to a Limited Distribution Drug in exchange for the drug manufacturer enjoying a position on the PBM’s formulary
  • PBM Prescription trolling, in which the PBM forces the prescription to be transferred to the PBM-owned pharmacy
  • Disparagement of competitors, at all levels of the PBMs (often vertically integrated)
  • Predatory pricing, such as below cost reimbursement, DIR Fees, and NADAC Medicaid pricing
  • Refusals to deal

Frier Levitt maintains a global competition lawyer on staff with experience in antitrust regulation, specifically within the PBM space. We have extensive experience representing pharmacies and providers in all types of matters against PBMs, with attorneys admitted in many jurisdictions around the country, including the venues selected by major PBMs for dispute resolution. Contact Frier Levitt today to speak to an attorney.