Over 400 pharmacies Sue Pharmacy Benefits Manager Optum Rx, Williams Cuker Berezofsky Announces

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On behalf of over 400 independent pharmacies nationwide, Williams Cuker Berezofsky has filed a lawsuit against the pharmacy benefits manager (PBM) Optum Rx, formerly known as Catamaran, due to alleged bad faith conduct in setting their reimbursements—primarily the use of MAC (Maximum Allowable Cost) pricing for generic drug prescriptions.

According to BTBKMK LLC, d/b/a Olexy Pharmacy V. OptumRx, f/k/a Catamaran Corporation - Case 01-16-0000-9295, filed by Williams Cuker Berezofsky in the American Arbitration Association, Optum Rx has annual revenue exceeding $60 billion and manages over 1.2 billion prescriptions each year.

Optum Rx determines the amount of reimbursement pharmacies receive for providing generic medications and other pharmaceutical products, the suit states. But the pharmacies allege that Optum sets unreasonably low reimbursement rates, based on irrelevant, inapplicable or outdated pricing data, all to the detriment of patients and pharmacies.

According to court documents, the pharmacies allege that Optum’s bad faith and lack of transparency effectively puts their business and continued delivery of patient services at risk.

The pharmacies claim in their suit the following specific acts of bad faith by Optum:

  • Allegedly, Optum consistently pays pharmacies MAC prices below the pharmacy’s acquisition cost, in violation of its contract with the pharmacies.
  • Allegedly, Optum required pharmacies who appealed below cost reimbursement to submit and document their invoice cost when they appealed MAC price.
  • For many drugs, Optum Rx allegedly pays the pharmacy a very low MAC price, while simultaneously billing the health plan a much higher brand name price.
  • When generic drug prices rise, it is alleged Optum bills the health plan the skyrocketed price while still paying the pharmacy the outdated lower price.
  • According to court documents, these practices are allegedly causing many independent pharmacies to lose money and go out of business, leaving patients without choice and the community pharmacist’s support and guidance in managing their health.

Mark Cuker, a partner with the consumer protection law firm Williams Cuker Berezofsky LLC, represents the pharmacies.

For over 30 years, Williams Cuker Berezofsky has represented small businesses in claims for unfair trade practices against major corporations.

For more information, contact the law firm at 215-557-0099 or visit their website at http://www.wcblegal.com/. Their offices are located in Philadelphia and New Jersey.

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Mark R. Cuker
@WCBLegal
since: 04/2015
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Williams Cuker Berezofsky
since: 05/2015
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