Nov 4 (Reuters) - Drug coupon aggregator GoodRx ( GDRX ) and

pharmacy benefit managers including CVS Caremark and

Express Scripts have been hit with at least three class action

lawsuits accusing them of working together to suppress

reimbursements to small pharmacies for generic prescription

drugs.

The first lawsuit was filed by Minnesota-based Keaveny Drug

in federal court in Los Angeles last Wednesday, and another was

filed in the same court on Friday by Michigan-based Community

Care Pharmacy. A third lawsuit was filed on Friday by

Pennsylvania-based Old Baltimore Pike Apothecary and Smith's

Pharmacy in Providence, Rhode Island, federal court.

Community Care sued only Los Angeles-based GoodRx ( GDRX ). The other

plaintiffs sued GoodRx ( GDRX ) and the PBMs, which also include

MedImpact Healthcare Systems and Navitus Health Solutions.

"CVS Caremark generally reimburses independent pharmacies at

higher levels than chain drugstores, including CVS pharmacies,"

CVS Caremark spokesperson Mike DeAngelis said in an email.

"These lawsuits are entirely without merit, and we will

vigorously defend against them."

The other defendants did not immediately respond to requests

for comment.

PBMs negotiate prescription drug prices between insurers,

pharmacies and drugmakers, and directly reimburse pharmacies for

prescription drugs under the terms of the plans they have

negotiated. They also offer discount cards that patients can use

at their pharmacy networks, which were historically often used

by people without insurance to pay for drugs out of pocket.

Until recently, according to the lawsuit, patients could

choose to use a discount card instead of their insurance plan if

it offered a lower price, but the payment would not be counted

toward their deductible. GoodRx ( GDRX ) is a service that patients can

use to check what discounts are available for a drug at a

particular pharmacy.

The three lawsuits allege that, starting last year, the PBMs

and GoodRx ( GDRX ) entered into agreements in which the PBMs would use

GoodRx's ( GDRX ) software to compare all available discounts for all

patients' generic drug prescriptions, and route each purchase

through the PBM with the lowest price - even if it was different

than the patient's PBM.

The pharmacy pays a fee, which under the new agreement is

split between the patient's PBM and the PBM that handles the

purchase. The PBMs do not reimburse pharmacies for these

transactions, meaning the patients' cash payment represents the

pharmacies' only revenue, and PBMs' profits increase, the

lawsuits say.

Large pharmacies, including those directly affiliated with

PBMs, such as CVS, can weather the lower reimbursements, but

independent pharmacies cannot, the lawsuits say. They allege

that the scheme aims to drive smaller pharmacies, which compete

with larger PBM affiliates, out of the market.

"These partnerships amount to price-fixing agreements that

enable the PBMs to allocate discount card transactions amongst

one another in real time, ensuring the PBMs pay the lowest

possible reimbursement rates to pharmacies on every

transaction," Old Baltimore Pike and Smith's said in their

lawsuit.

All of the lawsuits, brought on behalf of proposed classes

of similarly situated pharmacies, claim that the agreements

violate the federal Sherman Antitrust Act and ask for court

orders stopping further anticompetitive conduct. They also seek

unspecified amounts of money damages.

PBMs' business practices have drawn increasing scrutiny in

recent years, including by the U.S. Federal Trade Commission

accusing the three largest PBMs of driving up the cost of

insulin drugs.

The cases are:

Keaveny Drug v GoodRx ( GDRX ) et al, U.S. District Court for the

Central District of California, No. 2:24-cv-9379;

Community Care Pharmacy v. GoodRx ( GDRX ) et al, U.S. District Court

for the Central District of California, No. 2:24-cv-9490; and

Old Baltimore Pike Apothecary et al v. GoodRx Holdings ( GDRX ) et

al, U.S. District Court for the District of Rhode Island, No.

1:24-cv-00453.

For Keaveny Drug: Heidi Silton of Lockridge Grindal Nauen,

Bobby Pouya of Pearson Warshaw and others

For Community Care Pharmacy: Halley Josephs of Susman

Godfrey; Natasha Fernandez-Silber of Edelson and others

For Old Baltimore Pike Apothecary and Smith's Pharmacy: Greg

Asciolla of DiCello Levitt; Joshua Grabar of Grabar Law Office;

Steve Prignano of McIntyre Tate and others

For defendants: not available

Read more:

Why are US pharmacy benefit managers under fire?

(Reporting By Brendan Pierson in New York)