With New Lawsuits, GoodRx Gets Caught Up in Anti-PBM Animus
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Nov 14, 2024
Independent pharmacies have filed separate lawsuits against drug discount provider GoodRx and four of its partner PBMs, accusing the companies of a “conspiracy” to fix prices and suppress reimbursements to pharmacies. Industry experts say the litigation demonstrates how GoodRx, once a disruptive force in the pharmacy benefits sector, has now become more like a PBM itself.
At the heart of the lawsuits is the GoodRx Integrated Savings Program, which the company launched last year. Four PBMs — CVS Health Corp.’s Caremark, The Cigna Group’s Express Scripts, MedImpact Healthcare Systems, and Navitus Health Solutions — partnered with GoodRx to integrate the discounter’s pricing software into their claims processing systems, according to one of the lawsuits. The PBMs use GoodRx’s algorithm and each other’s negotiated reimbursement amounts to determine pharmacy reimbursements for prescriptions that patients fill with their insurance. Instead of processing the prescription through the patient’s regular PBM, it is processed through GoodRx. The patient is then automatically charged for the lowest rate negotiated by any PBM in the system.
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