AHF Wins $10+ Million Against Prime Therapeutics in PBM Price-Fixing Arbitration

Arbitrator issues interim award and Injunction to prevent future wrongdoing by Prime Therapeutics in antitrust case brought by AIDS Healthcare Foundation

LOS ANGELES--(BUSINESS WIRE)--AIDS Healthcare Foundation (AHF), the leading provider of health care to people living with HIV/AIDS around the world, won a monumental legal battle in an American Arbitration Association arbitration against Prime Therapeutics LLC (Prime), one of the nation’s largest pharmacy benefit managers (PBMs).

In a ruling Friday, January 17, Arbitrator Stuart M. Widman found that Prime Therapeutics had violated federal (Sherman Act) and state (Minnesota) antitrust laws in its business dealings with AHF after Prime entered into and performed what was ruled to be a price-fixing collaboration with Express Scripts (ESI), a competing and even larger PBM.

Arbitrator Wildman entered a damages award in favor of AHF and against Prime of “…a single recovery of trebled damages in the amount of $10,309,707,” and further awarded AHF injunctive relief permanently enjoining Prime from participating in its ongoing price-fixing collaboration with ESI with respect to the reimbursements made to AHF for the drugs and other pharmaceutical services that AHF provides to members of any healthcare benefit plans for which Prime is the PBM.

Prime also has been ordered to reimburse AHF for underpayments made since June 30, 2024 and until Prime ends the price-fixing gouging of AHF. That amount is likely to be in the multiple hundreds of thousands of dollars. AHF has also been awarded attorney fees.

“Through this case and with this ruling, the Prime-ESI ‘collaboration’ has been clearly exposed as per-se-illegal horizontal price-fixing—the cardinal sin of antitrust law and felonious behavior that government antitrust enforcement agencies, including the FTC, the Department of Justice’s Antitrust Division, and U.S. State Attorneys General, should help put a nationwide end to immediately, for all victims,” said Jonathan M. Eisenberg, AHF’s Deputy General Counsel-Litigation and lead counsel for AHF in the arbitration. “We are fearful that Prime and/or ESI now will retaliate against AHF by kicking AHF out of their pharmacy networks. However, AHF took this risk in the pursuit of justice to expose the illegal price-fixing ‘collaboration,’ not just for ourselves but to speak out on behalf of everyone affected by this ongoing criminal activity, including thousands of independent pharmacies and tens of millions of patients across the United States.”

Background

As a PBM, Prime is a “middleman” in the distribution system for prescription drugs in the United States. Prime acts as an intermediary between health insurers and pharmacies, as well as pharmaceutical manufacturers. Prime boasts of administering the pharmacy benefits components of health insurance plans for about 38 million people in the United States. Many of those people are patients of AHF pharmacies.

Since April 2020, Prime deliberately has been aligning its pharmacy reimbursement rates with those set by Express Scripts (ESI). The two PBMs no longer are competing on price to attract pharmacies into provider networks. This scheme harms not only AHF and other pharmacies directly, but also harms patients and the entire prescription drug pipeline.

Throughout the arbitration, Prime repeatedly sought to squash AHF’s free speech by petitioning arbitrator Wildman to halt or make AHF rescind press statements on favorable rulings in the case.

AIDS Healthcare Foundation (AHF), the world’s largest HIV/AIDS healthcare organization, provides cutting-edge medicine and advocacy to more than 2.2 million individuals across 47 countries, including the U.S. and in Africa, Latin America/Caribbean, the Asia/Pacific Region, and Eastern Europe. To learn more about AHF, visit us online at AIDShealth.org or ahf.org find us on Facebook, and follow us on Instagram, Twitter, and TikTok.