Express Scripts Sues Horizon Pharma for $140 Million

Express Scripts has been taking action against pricey drugmakers. The pharmacy benefit manager (PBM) filed a lawsuit against Horizon Pharma and removed specialty pharmacy Linden Care, which mostly dispensed Horizon drugs, from its network. Express Scripts is suing for $140 million.

The scrutiny and subsequent action follows revelations about the close ties between Valeant Pharmaceuticals International and mail-order pharmacy Philidor Rx Services, reported The Washington Post with Bloomberg.

In April, the Wall Street Journal reported that Valeant had bought the rights to 2 life-saving heart drugs and immediately increased their list prices by 525% and 212%. This incident is not isolated to Valeant, reporters Jonathan D. Rockoff and Ed Silverman pointed out. Horizon increased the price of Vimovo 597% after it bought the pain tablet and raised the price again at the beginning of 2015, and Express Scripts removed the product from its 2015 National Preferred Formulary.

“What’s described here isn’t pharmaceutical innovation,” the PBM published in its blog after the Journal article came out. “It’s profiteering. And it can’t be allowed if plan sponsors are to afford the breakthrough medications that patients truly need.”

This is not the first time Express Scripts and Horizon have been at odds with one another. After Express Scripts filed its lawsuit, Horizon pointed out that a year ago the biopharmaceutical company terminated a contract with the PBM after it failed to live up to it contractual obligations.

“The substantial majority of the monetary damages Express Scripts is seeking to recover are for prescriptions that occurred after the termination of the contract,” Horizon said in a published statement.

Horizon dismissed the Express Scripts claim that Linden Care is a captive pharmacy for the drugmaker, noting that less than 5% of its sales come from prescriptions filled by Linden and processed by Express Scripts.

“The notion that Linden Care is a so-called ‘captive pharmacy’ of Horizon Pharma is entirely false,” according to the statement. “At best Express Scripts is being reckless in its allegations and at worse it is intentionally attempting to mislead investors.”

Crain’s Chicago Business reported the lawsuit against Horizon seeking $140 million is because Express Scripts said the drugmaker “refused to honor certain contractual obligations” and the PBM is seeking “to recover money rightfully due its clients.”

Horizon is still reviewing the allegations in the complaint, but it believes the claims in the lawsuit are without merit.

“Our primary concern is for the patients who, based on the profit driven actions of Express Scripts, may be denied access to medicines that are prescribed by their physicians,” Horizon said in a statement.

Express Scripts will be evaluating other pharmacies that appear to dispense mostly Horizon Medications, said spokesman Brian Henry, according to Bloomberg Business.