United States District Court, E.D. Missouri, Eastern Division
REAL TIME PHARMACY SERVICES, INC. D/B/A MEDENVIOS HEALTHCARE, Plaintiff,
EXPRESS SCRIPTS, INC., Defendant.
OPINION, MEMORANDUM AND ORDER
EDWARD AUTREY UNITED STATES DISTRICT JUDGE
matter is before the Court on Plaintiff's Motion for
Temporary Restraining Order, [Doc. No. 9]. On March 30, 2017,
the Court held a telephone hearing on this matter, at which
both parties were represented by counsel. Arguments were
presented at that time. For the reasons set forth below,
Plaintiffs' Motion for a Temporary Restraining Order and
Preliminary Injunction is denied.
is a pharmacy in Miami, Florida. Plaintiff and Defendant
entered into a contract which consisted of a Pharmacy
Provider Agreement (“Agreement”)
and a Network Provider Manual.
November 3, 2016, Defendant initiated an investigation of
Plaintiff. The purpose of the investigation was to validate
that Plaintiff purchased diabetic testing supplies for which
it had billed Defendant. Defendant requested extensive
amounts of information from Plaintiff from July 1, 2016 until
October 31, 2016. The request was to confirm that Plaintiff
purchased sufficient quantities of the diabetic testing
strips for which it had billed Defendant.
contacted its supplier in an effort to comply with
Defendant's request. Plaintiff requested the supplier,
Masters Pharmaceutical to provide Defendant with information
necessary to validate its purchases.
November 18, 2016, Defendant sent an additional letter to
Plaintiff. It confirmed that Plaintiff and Masters had
responded to its request. The letter stated that it needed
additional information. Defendant requested lot numbers and
proof of product origination for invoices submitted by
Masters on behalf of Plaintiff in cooperation with
Defendant's request for three brands of diabetic testing
strips. Defendant claimed Plaintiff had obtained these strips
from an “unauthorized” distributor of the
notified Plaintiff and Defendant that it did not maintain the
lot numbers and proof of product origination because it was
not legally required to do so. Until the recent
investigation, Defendant had never requested the lot number
or proof of origination from Plaintiff or Masters.
December 5, 2016, Plaintiff contacted Defendant and included
a November 23, 2016 letter from Masters wherein Masters
states that it only purchased test strips from fully
qualified vendors, each of which had signed a Continuing
Supplier Warranty providing that the products Masters
purchases are authentic, lawfully sourced and in full
compliance with the law. This letter also made clear that
Plaintiff had conducted substantial due diligence to verify
the legitimacy of Masters and the diabetic testing supplies
it purchased from Masters. Plaintiff also noted that moving
forward, it would secure the lot number and proof of product
origination for all products.
January 12, 2017 Defendant sent another letter to Plaintiff
and stated that Defendant identified discrepancies totaling
$160, 414.14. On January 26, 2017, Plaintiff again asserted
its position that Defendant's claim of purchase
discrepancies and recoupment was incorrect and improper where
Plaintiff was able to prove it purchased its products from
March 16, 2017, Defendant notified Plaintiff that it was
terminating its relationship with Plaintiff and that
Plaintiff would no longer be considered a provider or
participating pharmacy in any of Defendant's networks.
Plaintiff claims this decision would effectively destroy its
Provider Manual sets forth specific policies and procedures
that Plaintiff was required to follow when submitting claims
to Defendant for reimbursement. When submitting claims for
diabetic supplies, including testing strips, the Provider
Manual expressly required Real Time (1) to ensure that the
diabetic supplies were purchased from authorized
manufacturers, and (2) to maintain pedigree or proof of
origin documentation for the products:
[Plaintiff] will validate the authenticity of all products
purchased and fully vet their wholesalers and suppliers.
[Plaintiff] will be required upon request to furnish pedigree
or proof of origin of products regardless of whether the
products submitted are prescription drugs or DME products,
including but not limited to diabetic supplies, testing
strips, lancets and glucometers. In the case of DME products,
[Plaintiff] is responsible for ensuring products are
purchased from suppliers that are authorized by the
manufacturer to distribute these products.
obligation to maintain records on the origins of diabetic
testing products is repeated in the Provider ...