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CareZone alleges Express Scripts is stifling other mail-order pharmacies. Photo: Tom Kelley/Getty Images

CareZone, an online service that delivers prescriptions to people's homes, is suing Express Scripts for allegedly engaging in anticompetitive behavior by locking out mail-order firms.

The bottom line: This dispute shines another light on how pharmacy benefit managers like Express Scripts profit from the drug supply chain — in this case, how it is more beneficial for PBMs to prefer their own mail-order pharmacies over others. Express Scripts denies CareZone's allegations.

The details: Express Scripts just threatened to end its contract with CareZone, CNBC reported this week. And now CareZone is retaliating by arguing Express Scripts took that action "to steer as many patients as it can to its own mail-order pharmacy, in order to thwart competition from innovative market entrants, and thereby increase profits."

  • PBMs determine which pharmacies are in-network for health insurance plans. Express Scripts specifically owns pharmacies that mail drugs to people at home.
  • Owning mail-order pharmacies and controlling contracts with insurance plans gives PBMs an incentive to direct patients to their own mail-order pharmacies even if cheaper options exist — thus, keeping all revenue.
  • The lawsuit alleges Express Scripts "allows pharmacies to sell prescription drugs to consumers through the 'retail, storefront' channel only, and expressly prohibits pharmacies from making sales to consumers through 'mail order.'"

Yes, but: CareZone's "innovative" model also is a complex business arrangement. The pharmacy, CZ Services, is separate from the mail-order company, CareZone, but they work together. Express Scripts' contract termination comes against CZ Services even though CareZone technically mails the drugs.

  • Express Scripts created a website that maintains CareZone broke the law with how it dispenses drugs.

Go deeper

Supreme Court agrees to hear challenges to Texas abortion law

Photo: Saul Loeb/AFP via Getty Images

The Supreme Court on Friday agreed to hear two cases challenging Texas' abortion law, which bans the procedure as soon as six weeks into pregnancy, but left the law in place in the meantime.

Why it matters: The court is moving extraordinarily fast on the Texas case, compressing into just a few days a process that normally takes months. And that schedule means the court will take up Texas' ban a month before it hears another major abortion case — a challenge to Mississippi's ban on abortions after 15 weeks.

Officials warn 5 key tech sectors will determine whether China overtakes U.S.

Illustration: Aïda Amer/Axios

U.S. intelligence officials responsible for protecting advanced technologies have narrowed their focus to five key sectors: artificial intelligence, quantum computing, biotechnology, semiconductors and autonomous systems.

Why it matters: China and Russia are employing a variety of legal and illegal methods to undermine and overtake U.S. dominance in these critical industries, officials warned in a new paper. Their success will determine "whether America remains the world’s leading superpower or is eclipsed by strategic competitors."

5 hours ago - Health

Pfizer says COVID vaccine over 90% effective in kids

Photo: Michael M. Santiago/Getty Images

Pfizer and BioNTech said their COVID-19 vaccine was more than 90% effective at protecting children between the ages of 5 and 11 from symptomatic infections from the virus, according to a study posted online by the FDA Friday.

Why it matters: Pfizer is seeking an emergency use authorization to vaccinate children — one of the last groups of Americans still largely ineligible to receive a coronavirus vaccine.