4 Min Read
(Adds background, Optum comment)
By Deena Beasley
Nov 13 (Reuters) - U.S. mail order pharmacy company Irmat is suing UnitedHealth Group pharmacy benefit unit OptumRx for its plans to drop Irmat from its network at the end of the month.
In the suit, filed late on Thursday in New York Supreme Court, Irmat said it received notice that it will be cut off from reimbursement by OptumRx, which operates a mail-order pharmacy that competes with Irmat, particularly for medicines that treat dermatological ailments.
Irmat is the latest specialty, mail-order pharmacy to be dropped by a payer. Last month, drugmaker Valeant Pharmaceuticals International Inc was accused of using its close ties with pharmacy Philidor Rx Services to improperly inflate revenue. Valeant has denied the allegations and cut ties with Philidor, prompting several payers to follow suit.
"We believe that Optum ... is taking these actions merely to force its members to use only its pharmacy for mail-order sales," said Matthew Cantor, a lawyer for Irmat.
OptumRx spokesman Matthew Stearns said that Irmat had been approved as a retail-only pharmacy in the OptumRx network but was providing pharmaceuticals by mail, which has different criteria. X
Several pharmacy benefit managers, including OptumRx, last month removed Philidor from their networks and said they are evaluating other pharmacies with links to drugmakers.
Express Scripts Holding Co, the largest U.S. pharmacy benefit manager, has cut Linden Care pharmacy from its network, citing close ties with drugmaker Horizon Pharma LLC .
Irmat, which existed only as a brick-and-mortar store on Park Avenue near Grand Central Terminal until 2013, said it had seen no problems in reimbursement from OptumRx since it began its mail-order business.
Irmat said those operations had grown at a rapid pace, with its revenue from OptumRx members rising from about $2 million in 2012 to $15.3 million in 2014. Irmat had projected that number would more than double to $33 million in 2015.
In its lawsuit, Irmat says it began in 2013 to participate in programs sponsored by drugmakers Galderma SA, a unit of Nestle SA and Aqua Pharmaceuticals, owned by Spain's Almirall SA, under which the manufacturers covered patient co-payments on leading dermatology drugs.
Galderma makes acne drug Differin, also available as a generic under the name adapalene, rosacea treatment Soolantra and others, while products from Aqua include acne treatment Acticlate, and antifungal gel Xolegel.
Irmat is seeking an injunction barring Optum from terminating or excluding it. The pharmacy said around 27 percent of its sales are to Optum members and the pharmacy benefit manager's actions put Irmat danger of going out of business.
In its complaint, Irmat says that termination by Optum will "deprive consumers of the cost-saving benefits that they enjoy through Irmat's participation in Galderma and Aqua programs," since OptumRx's mail-order pharmacy will not accept the promotional benefits offered by the drugmakers.
OptumRx's Stearns said Irmat could have attained the two accreditations it needed to become a mail-order pharmacy. "Nothing in their contract prevents Irmat or any other retail pharmacy network from pursuing those accreditations." (Additional reporting by Michele Gershberg and Caroline Humer; Editing by David Gregorio and W Simon)