Filing asserts Humana illegally imposed unfair and unconscionable fees on AHF pharmacies in breach of contractual obligations and contrary to applicable law and regulations
LOS ANGELES (September 19, 2024) – Fundação de Saúde SIDA (AHF), the world’s largest HIV/AIDS healthcare nonprofit, along with its affiliate Pharmacy4Humanity, have filed an reivindicação de arbitragem (AAA Case No. 012400077755) with the American Arbitration Association against Humana Pharmacy Solutions, Inc., Humana’s pharmacy benefit manager (PBM).
The filing claims that Humana’s PBM levied unfair and unconscionable fees on AHF pharmacies in breach of the PBM’s contractual obligations and contrary to applicable law and regulations. AHF asserts Humana illegally clawed back millions of dollars in reimbursements for AHF’s filling and dispensing of specialty medications to Medicare Part D plan beneficiaries living with HIV.
“Humana’s Quality Network Program has been a sham by its very nature. Humana’s program targets pharmacies that serve patients with chronic conditions like HIV who need expensive specialty medications. The program sets impossible metrics and then penalizes pharmacies by clawing back a percent of the pharmacies’ out of pocket drug cost. The cynical program has nothing to do with improving health outcomes. It is just a way of driving independent pharmacies out of business so patients go to Humana’s own specialty pharmacies. It is just a way of increasing Humana’s profits at the expense of independent specialty pharmacies,” said Jonathan Eisenberg, AHF deputy general counsel. “Today, AHF filed a complaint with the American Arbitration Association, alleging that Humana has imposed unlawful and unconscionable ‘DIR’ or ‘direct and indirect remuneration’ fees on AHF, clawing back over $27 million over the past seven years.”
AHF’s arbitration filing comes on heels of a blistering July 2024 Relatório FTC documenting how powerful pharmacy benefit managers like Humana’s squeeze Main Street, mom-and-pop, and other independent pharmacies like AHF’s, driving many out of business.
