In a momentous decision sure to shake up the PBM world, JLG lawyers led by Mark Cuker, Esq. won a years’ long court battle with Optum. The United States District Court ruled that Optum cannot enforce contract terms requiring arbitration when Optum (and its predecessor Catamaran) precluded the independent pharmacies from even seeing or accessing the contract to understand what it contained. The Court precluded Optum from enforcing these secret terms because the independent pharmacies never knew that there was an arbitration clause in their contracts. For this reason, the Court decided that Optum’s conduct was procedurally unconscionable and refused to enforce the arbitration clause as to all 430 of JLG’s independent pharmacy clients

In a significant decision that may change the PBM world and which could be a major step toward saving local independent pharmacies, JLG lawyers led by Mark Cuker, Esq. won a tremendous ruling: that within a single health insurance plan, Optum cannot reimburse an independent pharmacy using MAC prices that are lower than the MAC price used to reimburse a retail chain pharmacy or mail order pharmacy for a particular drug dispensed on the same date without breaching its own contracts.

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