JOHN A. ROSS, District Judge.
This matter is before the Court on Plaintiff's Motion for Temporary Restraining Order and Preliminary Injunction. (Doc. No. 5) The motion is fully briefed. Plaintiff Sorkin's Rx Ltd., d/b/a/CareMed Pharmaceutical Services ("CareMed") brings this action for violation of state and federal statutes governing anticompetitive behavior and healthcare regulations, as well as breach of contract and unjust enrichment, against Defendants Express Scripts, Inc. and Medco Health Solutions, Inc. ("Express Scripts") after receiving notice from Express Scripts that it was terminating CareMed from its network of pharmacies. CareMed contends that if Express Scripts is allowed to terminate their Provider Agreement, CareMed will be put out of business. CareMed seeks a temporary restraining order and preliminary injunction preventing its termination from Express Scripts' pharmacy network.
CareMed is a retail specialty pharmacy providing services to high-risk patients, which include the filling of prescriptions, delivery of medications, facilitating coverage of the medication by insurance companies, and assisting patients with the research of and application for co-payment assistance programs. (Compl. at ¶ 16) Express Scripts is a pharmacy benefit manager who, inter alia, administers and manages prescription drug programs for health maintenance organizations and insurance companies, which cover many of the specialty medications CareMed dispenses to its clients. (
On or about October 28, 2014, CareMed received a letter from Express Scripts notifying it that the Agreement would be terminated based on the fact that CareMed's owner pled guilty to fraud and failed to notify Express Scripts of the plea in violation of Section 1.2 of the Provider Manual. (Doc. No. 13-4) At CareMed's request, Express Scripts agreed to extend the termination date to permit additional information to be submitted and reviewed regarding CareMed's settlement of a qui tam complaint filed under the federal False Claims Act, 31 U.S.C. §§ 3730 (b) — (h) and the New York False Claims Act, N.Y. State Fin. Law § 190(2). As part of the settlement entered into on October 9, 2014, CareMed admitted that certain of its employees made false statements to insurance companies when seeking prior authorizations during the period from January 1, 2009 through December 31, 2012.
Express Scripts reviewed the additional information provided and, by letter dated November 14, 2014, notified CareMed that its termination would go forward on the grounds that CareMed did not abide "by key provisions in Provider's contract(s) with Express Scripts, including but not limited to Section 2.4 of the Network Provider Manual (requiring all information submitted to Express Scripts to be "accurate and complete"), Section 6.2 of the Network Provider Manual (prohibiting Provider from "knowingly making a false claim"), and Section 9.6 (agreeing that Provider will comply with the terms of the False Claims Act). In addition, Provider's admissions establish that Provider does not meet Express Scripts' standard terms and conditions for participation with Express Scripts." (Doc. No. 13-5)
Express Scripts postponed the termination twice more and, on December 22, 2014, finally notified CareMed that it would be terminated effective January 15, 2015. This action was filed on January 14, 2015, one day prior to the effective date of the termination. Express Scripts maintains that it no longer trusts that CareMed is suited to maintain the high standards of integrity required of pharmacies in its provider network and that the relationship between Express Scripts and CareMed is over.
"[T]he basis of injunctive relief in the federal courts has always been irreparable harm and inadequacy of legal remedies."
In order to be entitled to injunctive relief, CareMed must establish a substantial likelihood of prevailing on the merits of its claims.
CareMed alleges that Express Scripts' reasons for terminating the Agreement are pretextual and that its real purpose for terminating the Agreement is to divert thousands of patients from CareMed to Express Scripts' own specialty pharmacy as part of its continuing monopolization of the market. (Compl. at ¶¶ 52, 58) In its memorandum in support of its motion for injunctive relief, CareMed also contends that Express Scripts failed to comply with the dispute resolution procedure required under section 7.12 of their Agreement
In response, Express Scripts points first to the limiting language of section 7.12 ("except as provided herein") as well as Section 4.2.c of the Agreement which provides for immediate termination without caveat. Next, Express Scripts argues that section 7.12 was not triggered by its notice of termination because such a notice is not a "legal action." Third, Express Scripts asserts that the parties have "met and conferred" on numerous occasions since the initial termination notice was sent on October 24, 2014. Specifically, Express Scripts extended the termination of CareMed several times to give it an opportunity to submit documentation to refute Express Scripts' findings. Finally, Express Scripts responds that CareMed has offered no evidence that it did not submit fraudulent claims or that its actions did not violate the Agreement.
At this stage of the proceedings, the Court cannot predict which side is likely to prevail at trial. The fact that Express Scripts' first notice of termination was based on incorrect information gives the impression that Express Scripts was looking for a reason to terminate CareMed from its pharmacy network. At the same time, CareMed cannot deny that as part of the settlement of the False Claims Act action it made admissions that its representatives falsely represented to insurers that they were calling from a physician's office to obtain prior authorization. Those false statements would appear to violate the terms of the Agreement. The Court need not resolve these issues, however, because CareMed has not demonstrated that it is likely to suffer irreparable harm in the absence of injunctive relief.
Regardless of the strength of its claim on the merits, a movant for preliminary injunctive relief must show a threat of irreparable harm.
CareMed argues that the loss of membership in Express Scripts' network will put it out of business. In support of that argument it submits the affidavit of its President, Nuaman Tyyeb. (Doc. No. 6-1) Mr. Tyyeb states that CareMed currently provides services for approximately 7,800 patients in the State of New York suffering from critical or chronic diseases who require medication. Mr. Tyyeb states that the premature termination of the Agreement will severely disrupt the continuity of care these patients receive. He estimates the revenues associated with these patients at $69 million for the period January 1, 2014 through September 30, 2014, representing a "significant portion" of CareMed's business. CareMed contends that the sudden loss of this revenue "almost certainly will cause CareMed to become insolvent and CareMed will be forced to lay off 75 employees immediately." (Doc. No. 6 at 8) Mr. Tyyeb also states that the exclusion of CareMed from Express Scripts' network will result in irreparable reputational harm in the industry of pharmacy benefit managers and loss of customer goodwill. (
Express Scripts responds that CareMed has provided no evidence of the harm it expects to suffer aside from Mr. Tyyeb's conclusory and self-serving statements. (Doc. No. 12 at 12-14) Moreover, CareMed's alleged injuries are not "irreparable" in the sense that they could be addressed through money damages if CareMed is successful following a trial on the merits. (
In
Similarly, in
This case is fundamentally a breach of contract case. The Agreement at issue provides that Express Scripts may terminate the Agreement immediately upon certain circumstances (Doc. No. 4-2 at § 4.2c) and without cause on at least 30 days' written notice. (Doc. No. 4-2 at § 4.2a) Like the plaintiff pharmacies in
CareMed asserts that Express Scripts comprises 40% of its customer base but provides no evidence to support that assertion. CareMed contends that its termination from Express Scripts' network will have a "domino effect with other [pharmacy benefit managers] . . . leading to the destruction of CareMed's business" (
Likewise, CareMed's claim of intangible injuries such as damaged goodwill and reputation is supported by nothing more than general business principles and therefore too speculative to establish irreparable harm.
Although failure to demonstrate irreparable harm is itself a sufficient ground to deny injunctive relief,
Express Scripts maintains that an injunction of the type CareMed requests would force it to continue doing business with CareMed and harm its ongoing operations and reputation as well as the integrity of its pharmacy provider network. (Doc. No. 12 at 18-19) Like the courts in
Further, CareMed offers no evidence that any members of Express Scripts' clients will be left without medication or access to medication if it is terminated from the network. Express Scripts submits a declaration of Thomas Luft, Senior Director for Provider Contracting and Strategy, as evidence of the efforts it made to notify members of CareMed's termination. (Doc. No. 13) Luft states that Express Scripts followed its internal procedures to ensure that its health plan sponsor clients could timely notify members of CareMed's termination and extended CareMed's participation in network to allow for additional notification of members. (
In summary, the Court has examined the balance of the equities in light of the
Accordingly,