UnitedHealth Group, AARP File Suit Against AdvancePCS for Diverting Patients from Rival PBM
Minnesota-based insurer UnitedHealth Group and the AARP have filed a lawsuit in U.S. District Court in Minnesota against pharmacy benefit manager AdvancePCS, accusing the company of "illicitly diverting" patients from an AARP pharmacy discount plan administered by UnitedHealth and "putting them at risk for potentially dangerous drug interactions," the Wall Street Journal reports. The dispute between the companies began in September, when AARP moved its prescription drug discount card business from AdvancePCS to UnitedHealth, which already operated several health plans for AARP. UnitedHealth then subcontracted the discount card program to PBM Express Scripts Inc, which is not a party in the suit. The suit, filed in December, claims that after it lost the AARP contract, AdvancePCS launched a new discount card plan that pharmacists could access through their computer systems with the same code that AdvancePCS had used for its AARP plan. As a result, AARP patients who visited a pharmacy with their prescription but without their new Express Scripts discount card "could be routed" to the AdvancePCS plan, the Journal reports. The suit claims that AdvancePCS also offered pharmacists a $3 enrollment fee for each new member who used their new plan at least six times. Express Scripts did not offer a similar reward. Express Scripts said that the number of AARP prescriptions decreased by 56% from August, when AdvancePCS last had the contract, to September.
AARP said that many of the group's members "are simply being switched without their knowledge" to the AdvancePCS pharmacy discount card plan through a "scheme of deception." AARP and UnitedHealth are seeking to recover $56 million in damages from AdvancePCS -- $53.5 million of which is sought by UnitedHealth -- and to prevent the PBM from using the access code earlier used by AdvancePCS. UnitedHealth said that the damages include lost income and the costs required to recover lost business. AdvancePCS argues that the "move to keep the same access code," which the PBM owned, "made good business sense." Susan de Mars, general counsel for AdvancePCS, said, "It's not our fault they failed to adequately educate pharmacies and members about what was happening to the AARP benefit and why they should continue to participate in it." But Robert Milman, director of member health products at AARP, said, "We're concerned about our reputation and our members thinking they're participating in a program that we make available to them, when in fact in some cases they're not." The lawsuit also argues that AdvancePCS has placed the group's members at "an increased risk of physical harm." AARP's discount card plan includes a system to help prevent adverse drug interactions that AARP says AdvancePCS cannot recreate. However, AdvancePCS "plays down the benefit" of the AARP system and "says it, too, can look for dangerous drug interactions," the Journal reports (Martinez, Wall Street Journal, 2/12).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.