In Brief: A Digest of Pharmacy Benefit Managers Projects

Client Success

Assisted a pharmacy benefit manager in structuring research studies with outside collaborators to comply with HIPAA patient privacy and data security requirements.
Structured and negotiated pharmacy benefit manager (PBM) rebate arrangements and pharmacy arrangements with pharmaceutical manufacturers to ensure compliance with applicable Fraud and Abuse laws.
Represented and negotiated on behalf of a pharmacy benefit manager in commercial client contracting matters.
Advised a pharmacy benefit manager on specialty pharmaceutical drug spend management products and offerings;
Worked on-site for a pharmacy benefit manager and assisted with compliance matters, network provider contracting and policy drafting.
Advised pharmacy benefit managers in areas such as rebates/discounts, specialty pharmacy contracting and group purchasing.
Assisted a pharmacy benefit manager with creating its Medicaid Managed Care compliance program.
Lead counsel for Express Scripts, Inc. in a confidential arbitration proceeding before the American Arbitration Association (AAA) brought by one of the Northwest’s largest health plans. After a four day hearing, the AAA found entirely in favor of Express Scripts.
Trial counsel for Express Scripts in jury trial involving breach of contract claims brought by a compounding pharmacy. After a weeklong trial, jury returned a complete defense verdict in favor of Express Scripts. Alt. Med. Pharmacy, Inc. v. Express Scripts, Inc., No. 4:14-cv-01469-CDP (E.D. Mo.)
Multiple successes in defending pharmacy benefits manager against claims for injunctive relief relating to the termination of compounding pharmacies. Alternative Medicine and Pharmacy, Inc. v. Express Scripts, Inc., et al., 2014 WL 4988199, at *6 (E.D.Mo. Oct. 7, 2014); Sorkin's Rx Ltd. v. Express Scripts Inc., 2015 WL 249488 (E.D.Mo.); and Trilogy Health Care, LLC v. Medco Health Solutions, Inc., 2013 WL 4832708 (D.N.J. Sept. 10, 2013).
Lead trial counsel for Express Scripts in a multiple day preliminary injunction hearing involving claims brought by a terminated pharmacy. Linden Care, LLC v. Express Scripts, Inc., No. 1:15-cv-01335-BKS-CFH, 2015 WL 12734164 (N.D.N.Y. Dec. 7, 2015)
Lead counsel for pharmacy benefits manager in a confidential arbitration proceeding involving wrongful termination and breach of contract claims. After a five day hearing, the AAA denied Claimant’s request for injunctive relief and the claim was subsequently dismissed.
Lead counsel for pharmacy benefits manager in commercial dispute relating to audits performed of a pharmacy.
Class certification denied in putative multidistrict class action alleging violations of ERISA, breach of fiduciary duty, and consumer fraud, against a Fortune 100 pharmacy benefits management company. In re Express Scripts, Inc., PBM Litigation, No. 4:05-mdl-01672-HEA, 2015 WL 128073 (E.D. Mo., Jan. 8, 2015).
Summary judgment in favor of client, a Fortune 100 pharmacy benefits management company, in putative consumer fraud class actions and multi-district litigation. In re Express Scripts, Inc., PBM Litigation, No. 4:05-mdl-1672-HEA (E.D. Mo. March 31, 2014)
Class certification denied and summary judgment granted in favor of client, a Fortune 100 pharmacy benefits management company, on key Employee Retirement Income Security Act (ERISA) claims. In re Express Scripts Inc. PBM Litigation, 2008 WL 2952787 (E.D. Mo. 2008)