But the Philidor example shows how some pharmacies are being used to dispense more ordinary, and expensive, prescriptions. Philidor was selling Jublia, a toenail fungus treatment that retails for about $500 for a small bottle. The treatment is only moderately effective: it cured about 18% of patients in one clinical trial after one year.
Linden Care was selling Duexis, Horizon’s top drug, which combines the common pain killer ibuprofen and famotidine, the generic version of heartburn drug Pepcid. It costs about $500 for a 30-day supply.
Valeant has denied allegations that it used Philidor to inflate revenue, but is in the process of cutting its distribution arrangements with the pharmacy. Philidor, which will soon shut down, insists its employees behaved ethically.
This week, Linden Care Pharmacy sued Express Scripts, while New York City-based Irmat Pharmacy sued OptumRx for moving to terminate their contracts.
At Irmat, 60% of the prescriptions being sent to OptumRx for payment were from two drugmakers, a source familiar with the situation said. Irmat said in its lawsuit that revenue skyrocketed after it contracted in 2013 with Nestle SA’s Galderma SA, and Aqua Pharmaceuticals, part of Spain’s Almirall. Neither company was immediately available for comment.
Eileen Wood, chief pharmacy officer at CDPHP, said the health plan rejected 4,700 claims from Philidor and related pharmacies this year, nearly all of which were for Valeant products. CDPHP works with CVS for pharmacy benefits.
Wood also called “very suspicious” the 477 claims CDPHP received from Linden Care this year, noting that 90% were for drugs from Horizon or its subsidiaries. All were rejected.
Officials at Linden Care did not respond to requests for comment.
