Prime Therapeutics Fails to Silence AHF in PBM Price-Fixing Arbitration
July 30 2024 - 12:32PM
Business Wire
Arbitrator denies gag order motion against AIDS
Healthcare Foundation for second time
AIDS Healthcare Foundation (AHF), the leading provider of health
care to people living with HIV/AIDS around the world, won another
legal battle in an American Arbitration Association arbitration
against Prime Therapeutics LLC, one of the nation’s largest
pharmacy-benefit managers (PBMs).
On Friday, July 26, Arbitrator Stuart M. Widman denied Prime’s
motion seeking a gag order and monetary sanctions against AHF for
issuing a press release about the nonprofit’s price-fixing case
against the PBM. AHF has sued Prime over its questionable business
“collaboration” with Express Scripts, Inc. (“ESI”), a direct
business competitor, which has harmed AHF and other independent
pharmacies.
On July 10, Prime lost a motion for summary adjudication of the
case. After Arbitrator Widman issued that ruling, AHF issued a
press release welcoming it. That exercise of free speech prompted
Prime to seek a gag order, which was denied.
“Prime tried to silence AHF for commenting about the arbitration
proceedings, which Prime wants to be completely confidential,” said
Jonathan M. Eisenberg, AHF’s Deputy General Counsel –
Litigation and lead counsel for AHF in the arbitration. “But
Arbitrator Widman confirmed that AHF did not warrant a gag order
because AHF had not disclosed any truly confidential Prime
information. Arbitrator Widman even pointed out that AHF had
accurately reported that he was ‘leaning toward’ finding that the
Prime-ESI ‘collaboration’ is per-se-illegal price-fixing.”
Last summer (2023), after AHF prevailed against Prime’s motion
to dismiss the case and AHF issue a press release about that
victory, Prime similarly asked the prior arbitrator, the Hon. David
R. Cohen, to make AHF retract the press release and make the
arbitration proceedings completely confidential. Arbitrator Cohen
denied that request.
Background
As a PBM, Prime is a “middleman” in the distribution system for
prescription drugs in the United States.1 Prime acts as an
intermediary between health insurers and pharmacies, as well as
pharmaceutical manufacturers. Prime boasts of administering the
pharmacy-benefits components of health insurance plans for about 38
million people in the United States. Many of those people are
patients of AHF pharmacies.
Since April 2020, Prime deliberately has been aligning its
pharmacy reimbursement rates with those set by ESI. The two PBMs no
longer are competing on price to attract pharmacies into provider
networks. This scheme harms not only AHF and other pharmacies
directly but also harms patients and the entire prescription drug
pipeline.
- July 26, 2024, Prime/AHF Arbitration: Ruling on Motion for
Protective Order And Monetary Sanctions link
- July 10, 2024, Prime/AHF arbitration summary adjudication
ruling link
AIDS Healthcare Foundation (AHF), the world’s largest
HIV/AIDS healthcare organization, provides cutting-edge medicine
and advocacy to more than 2 million individuals in 47 countries in
the US, Africa, Latin America/Caribbean, the Asia/Pacific Region,
and Eastern Europe. To learn more about AHF, visit us online at
AIDShealth.org, find us on Facebook, follow us on Instagram and
Twitter, and subscribe to our Ahfter Hours podcast.
1 Note: Prime is, in fact, owned by a group of Blue Cross and/or
Blue Shield health insurers.
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version on businesswire.com: https://www.businesswire.com/news/home/20240730922697/en/
Media Contact: Ged Kenslea, AHF Senior Communications
Dir. gedk@aidshealth.org (323) 791-5526