AmeriHealth Caritas and its pharmacy benefits manager subsidiary, PerformRx, is facing a lawsuit from two Philadelphia pharmacies alleging the companies illegally concealed transmission fees.
The complaint from Friendly Pharmacy and Samuel J. Robinson Pharmacy alleges PerformRx charged pharmacies transmission fees after the fact, rather than at the point of sale during real-time claim adjudication. The pharmacies argued this is a violation of state law and said the PBM and AmeriHealth Caritas “actively concealed and obfuscated the charging of transmission fees.”
“In some instances, defendants’ wrongful practices resulted in reducing the amounts that PerformRx actually paid after the fact to pharmacies to nearly zero,” the complaint said, adding that other PBMs properly disclosed the fees.
The pharmacies filed the proposed class action in April in a Philadelphia court, but it is now being handled by a federal court. They are seeking injunctive relief, a declaration of liability, full reimbursement plus penalties and treble damages.
The Philadelphia Inquirer reported Friendly Pharmacy’s closure in 2024, and Samuel J. Robinson Pharmacy announced its closure on Facebook last fall.
A 2024 Pennsylvania audit found PerformRx had been transparent with pharmacies, but not managed care organizations and the state’s Department of Human Services, regarding transmission fees throughout 2022.
This year, AmeriHealth Caritas confirmed it is moving away from PerformRx, looking to UnitedHealth Group’s Optum Rx instead “after a multiyear review.”
“PerformRx will conclude its PBM operations in their current form on Dec. 31, 2026,” a spokesperson previously told Becker’s. “We expect a limited impact on jobs, with many functions remaining in-house.”
Independence Blue Cross and Blue Cross Blue Shield of Michigan jointly own AmeriHealth Caritas, a Medicaid managed care organization with members in 13 states and Washington, D.C.
AmeriHealth Caritas told Becker’s it does not comment on pending litigation.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.