Optum Rx sued by Michigan pharmacy for alleged retaliation, defamation

"None of Optum Rx's audits have revealed any notable irregularities in iPharmacy's business," the company said.

At one point, Optum Rx sent patients letters in the name of Blue Cross Blue Shield of Michigan and Michigan Blue's Blue Care Network stating that Blue Cross Blue Shield of Michigan and Michigan Blue's Blue Care Network "periodically review the services provided by network pharmacies as part of their fraud detection efforts."

"The purpose of our review is to confirm the validity of prescriptions that were billed and paid for through your health plan," according to an excerpt from the letter quoted in the complaint.

"The letters give the impression that Blue Cross Blue Shield is initiating the fraud detection efforts, when in reality it is Optum Rx," iPharmacy said. "Optum Rx is using Blue Cross Blue Shield in the letters as cover for its true motivations — retaliation against iPharmacy."

The pharmacy has accused Optum Rx of business defamation, interference with business relationships, injurious falsehood, and invading its privacy.

Representatives for Optum Rx could not immediately be reached for comment.

The backdrop: IPharmacy filed the suit at a time when pharmacies and PBMs are engaged in active policymaking efforts in Congress and state legislatures.

Pharmacies have persuaded states to adopt new PBM laws in the past few years in Illinois, Massachusetts and many other states.

The PBMs have accused the big PBMs of using their large size and ownership of mail-order pharmacies to crowd out independent pharmacies.

The big PBMs say that they are facing anger because of their successful efforts to hold down drug spending for employers, patients and payers by squeezing costs out of the U.S. prescription drug sector in ways that narrow other players' profit margins.

OptumRx's new reimbursement strategy: Optum Rx responded to pharmacies' concerns about reimbursement rates Tuesday by announcing that it's increasing reimbursement minimums for brand-name drugs dispensed by about 2,300 independent pharmacies that are not affiliated with a pharmacy chain, pharmacy services administrative organization or other large organization.

The change took effect Sept. 1, according to Optum Rx.

"This positive change will help ensure that prescriptions filled by independent pharmacies are reimbursed at a positive margin," the company said.

OptumRx is also improving reimbursement for its in-network pharmacies, and about 24,000 are eligible for increased reimbursement through the Optum Rx Independent Pharmacy Network, the company said.