Express Scripts, a pharmacy benefit manager, dropped Linden Care from its network of US pharmacies, saying Linden hid the fact it is a mail order-only pharmacy and broke rules by deliberately dispensing Horizon Pharma drugs when others were cheaper.
Pharmacy benefit management companies act as a go-between for pharmacies and drug manufacturers, often negotiating discounts on medicines on behalf of insurers.
Express spokesperson Brian Henry told in-Pharmatechnologist.com Express removed Linden Care from its network of 70,000 pharmacies because “at a high level, they misrepresented themselves as a retail pharmacy when in fact they were more of a mail order pharmacy, and so for that reason among others we decided to remove them from the network.
When we asked about the connection with Horizon Pharma, Henry told us, “Another part of this is we’re finding there are pharmacies here in the US which are distributing a large percentage of drugs from one manufacturer [...]. That was one reason among several why we decided not to include Linden Care in our network.”
‘Captive pharmacy’ accusations
“We find in some of these cases there is a ‘captive pharmacy’,” Henry told us, meaning “the pharmacy is only really sending out either one drug from a manufacturer or a suite of drugs from a manufacturer. In some cases those pharmacies are trying to circumvent the cost solutions our clients put in place to make drugs more affordable and accessible.”
Express is hired by companies, unions and health plans to manage pharmacy discounts and keep costs low – “so certain drugs are selected or kept off a formulary that one of these companies will provide to its members. When we find that pharmacies are trying to get around those solutions and are […] in fact raising the cost of care – that’s something that we look at very closely,” said Express’s spokesperson.
Horizon: Express is ‘profiteering’
But Horizon denied Express’s claims, saying less than five per cent of its sales come from drugs dispensed by Linden, and Express “is being reckless in its allegations and at worst it is intentionally attempting to mislead investors.”
Horizon CEO Timothy Walbert accused Express Scripts of “profiteering” and being anti-competitive.
"Express Scripts is not only a pharmacy benefit manager that has significant control over prescriptions that flow to specialty pharmacies, it also operates its own mail-order pharmacy and thus is a direct competitor of small, independent specialty pharmacies throughout the United States. This competitive role, in our view, creates a clear conflict of interest, as Express Scripts stands as both a pharmacy's overseer and competitor.
In fact, Express Scripts' specialty pharmacy, Accredo Health Group, Inc., is the largest in the United States with more than 28 percent market share. Based on its Accredo ownership, it's not surprising that Express Scripts would target small, competitive independent specialty pharmacies in order to force those pharmacies from its network, attempt to dominate the U.S. specialty pharmacy medicine distribution channel and further boost its own profits at the expense of patients.”
Horizon has an agreement with Express-owned Accredo to distribute some of its orphan drugs but Walbert said the company will now “re-evaluat[e] this relationship.”
Linden Care in turn has denied all Express’s claims and says it is independent and no pharma company owns a stake in it.
In a legal complaint, it said that if Express does not temporarily reinstate Linden pending a hearing, patients who are unable to access their medicines through other channels will suffer.