A federal judge in St. Louis dismissed antitrust claims brought by the AIDS Healthcare Foundation against pharmacy benefit manager Express Scripts on Tuesday, ruling the nonprofit had already had its chance to bring those arguments in a prior lawsuit and could not relitigate them now.
U.S. District Judge Maria A. Lanahan, a Trump appointee, found that AHF’s 2024 lawsuit was barred by the legal doctrine of claim preclusion — essentially, that the same core allegations had already been litigated and dismissed in a previous federal case.
Background: What AHF Alleged
The AIDS Healthcare Foundation operates a nonprofit specialty pharmacy in Louisiana focused on serving HIV/AIDS and hepatitis C patients — some of the most vulnerable patients in the American healthcare system. AHF sued Express Scripts and its subsidiary Accredo Health Group Inc. in Missouri federal court in 2024, alleging the pharmacy benefit manager was abusing its market power to crush competition among specialty pharmacies in Louisiana.
At the heart of AHF’s complaint was the allegation that Express Scripts used its dominant position as a pharmacy benefit manager to create an effective monopoly for its own subsidiary, Accredo, by imposing anticompetitive contract terms on independent specialty pharmacies. AHF claimed those terms — including performance incentives and reimbursement structures — left independent pharmacies like itself unable to compete on fair terms.
The foundation sought an injunction to stop Express Scripts from enforcing the terms of a 2017 Pharmacy Provider Agreement between the parties, as well as monetary damages.
The Prior Lawsuit Problem
The case ran into a significant legal obstacle: AHF had already sued Express Scripts over similar allegations, and that lawsuit was dismissed in February 2023 for failure to state a plausible claim for relief.
Judge Lanahan found that AHF’s 2024 claims arose from the same underlying facts and the same contract — the 2017 Pharmacy Provider Agreement — as the earlier dismissed case. Under Missouri law, which governs the claim-preclusive effect of the prior federal judgment, parties are prohibited from claim splitting — filing successive lawsuits based on the same underlying transaction or set of facts.
“Here, the foundation’s claims are precluded because they arise from the same facts and circumstances as its claims in its prior case against Express Scripts,” Lanahan wrote.
The judge noted that both lawsuits centered on the same core allegation: that Express Scripts leveraged its market power as a pharmacy benefit manager to impose arbitrary and one-sided contract terms resulting in AHF being reimbursed at below-market rates. Both cases also sought the same relief — an injunction and damages tied to the 2017 agreement.
AHF’s Defense — and Why the Judge Rejected It
AHF argued the two lawsuits were actually different in meaningful ways. The foundation pointed out that the 2024 case involved entirely different operative facts, included new information that only came to light after the prior lawsuit, and added Accredo as a defendant — a party that was not named in the earlier case.
Lanahan was unpersuaded. She found that the “one central allegation” in both cases was identical: that Express Scripts imposed anticompetitive contract terms through its bargaining power as a pharmacy benefit manager.
AHF also argued it could not have brought the 2024 claims in the earlier lawsuit because it was unaware of the basis for those claims until 2024. Lanahan rejected that argument too, pointing to AHF’s own allegations that Express Scripts had “drastically cut its reimbursement payments” to the foundation around January 2021 — well before the prior lawsuit was dismissed.
“The foundation’s only excuse for not bringing these claims in the first case is that ‘it was unaware of the basis for’ its contract claims until 2024,” Lanahan wrote. “But the foundation’s own allegations negate this argument.”
What Is a Pharmacy Benefit Manager?
Pharmacy benefit managers, or PBMs, are intermediaries that negotiate drug pricing between insurers and pharmacies. The three largest PBMs — Express Scripts, CVS Caremark, and OptumRx — together manage prescription drug benefits for the majority of insured Americans.
Critics argue that PBMs use their enormous market power to favor their own affiliated pharmacies over independent competitors, squeezing out smaller pharmacies and ultimately raising costs for patients. The Federal Trade Commission has been conducting an ongoing investigation into PBM practices, and Congress has held multiple hearings on the issue in recent years.
Implications for Independent Pharmacies
The dismissal is a setback not just for AHF but for independent specialty pharmacies more broadly. The case was closely watched as an example of a smaller pharmacy using antitrust law to challenge PBM dominance — a strategy that advocates for independent pharmacies have pushed as a way to level the playing field.
With the antitrust claims now dismissed on procedural grounds rather than the merits, the underlying question of whether Express Scripts’ conduct violated antitrust law was never actually decided. That leaves open the possibility of future litigation on those questions by AHF or other pharmacies, provided they can structure their claims to avoid the procedural pitfalls that doomed this case.
Neither the lead attorney for AHF nor the lead attorney for Express Scripts responded to requests for comment.
InjuryWatch News will continue tracking antitrust developments in the pharmacy benefits sector.