Federal lawsuit asserts PBM’s monopoly power in Louisiana costs AHF substantial revenues and harms its ability to provide lifesaving care

AIDS Healthcare Foundation (AHF) – the world’s largest HIV/AIDS healthcare organization which cares for more than 195,000 people in the United States and is an essential safety-net provider for disenfranchised, high-risk HIV/AIDS populations – has filed a federal lawsuit (U.S.D.C., E.D. Mo., Case No. 4:24-01043) against the pharmacy benefit manager (PBM) Express Scripts, Inc. and its subsidiary, Accredo Health Group, Inc.

AHF asserts federal antitrust claims and claims of state unfair trade practices over Express Scripts’ use of its monopoly power as a PBM in Louisiana to impose anticompetitive restraints to destroy competition among specialty pharmacies like AHF’s.

AHF’s lawsuit comes on the heels of a blistering 115-page FTC report documenting how powerful PBMs like Express Scripts squeeze mom-and-pop and independent pharmacies, driving many out of business.

“Express Scripts unilaterally imposes arbitrary contract terms on specialty pharmacies like AHF and, by extension, our patients,” said Laura Boudreau, Chief of Operations, Risk Management and Quality Improvement for AHF. “Yet, because Express Scripts is the dominant PBM by far in Louisiana, AHF and other specialty pharmacies have no choice but to accept Express Scripts’ terms there. As a result, the PBM hinders independent specialty pharmacies from being able to compete long-term.”

Together, Cigna’s Express Scripts, United Health’s Optum Rx, and CVS Caremark PBMs currently control 83 percent of the prescription drug market in the United States. Express Scripts controls access to more than 70 percent of individuals covered by health plans in Louisiana, including those who need, or may need, specialty drugs for treating HIV and hepatitis C as well as other very expensive specialty drugs not available in most traditional pharmacies.

The lawsuit, prepared by Kesselman Brantly Stockinger LLP of Manhattan Beach, CA, and filed by McCarthy, Leonard & Kaemmerer, L.C. of Town & Country, Missouri, was filed Friday in U.S. District Court, Eastern District of Missouri, on behalf of AHF.

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.

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