Judge Grants Summary Judgment to BCBS in Senderra Rx Case Alleging Unfair Membership Reqs.

Judge Catherine C. Eagles of the Middle District of North Carolina on Monday granted summary judgment to Blue Cross and Blue Shield of North Carolina (BCBSNC), the defendant in Senderra Rx Partners LLC’s suit alleging that BCBSNC violated state statute through purportedly blocking the plaintiff’s entry into the defendant’s “specialty pharmacy network” and engaging in other unfair and deceptive trade practices.

The court ruled in favor of summary judgment for the defendant “(b)ecause there are no disputed questions of material fact and the evidence shows that Senderra is not aggrieved by BCBSNC’s allegedly unlawful actions,” the opinion said.

The allegedly unlawful actions that Senderra highlighted in its lawsuit centered around BCBSNC’s pharmacy network membership requirements, which changed in 2018. Upon joining the network in 2015, Senderra said it only had to provide proof that it had a “staffed business office” in North Carolina; under the new terms, Senderra had to have a “dispensing location” in the state, the court explained, which it did not have. Accordingly, BCBSNC notified Senderra that its membership in the network would be terminated, effective Oct. 15, 2018.

In an effort to save its participation in the network, Senderra bought a business to convert it to a dispensing pharmacy to meet the in-state dispensary requirement — but it did not receive a dispensing permit with the North Carolina Board of Pharmacy before the required compliance date of Oct. 1, 2018, so its membership was ended. Pursuant to the network agreement terms, the earliest Senderra would be able to gain entry back into the network was July 1, 2019, as long as it met the requirements by April 1, 2019.

Senderra reapplied on Nov. 5, 2018, once it received its dispensary permit; however, BCBSNC rejected the application for lack of a Medicare certification and a Utilization Review Accreditation Commission (URAC) credential, the court explained. Senderra eventually obtained the proper credentials and was admitted back into the network July 1, 2019.

Despite Senderra’s reentry into the network, it argued that BCBSNC rejecting it from participating from Oct. 15 to July 1, 2019, made it miss out on “millions of dollars in revenue and profits,” claiming that BCBSNC issued “vague” and “conflicting” instructions on how to satisfy the network entry requirements while falsely representing them and enforcing them with “unequal force and manner,” according to the plaintiff. The plaintiff further alleged that the defendant violated the state’s “Pharmacy of Choice” statute and participated in unfair and deceptive trade practices.

The court sided with the defendant on all fronts, finding that Senderra did not establish its injury as a result of the BCBSNC’s alleged conduct. Unconvinced by the plaintiff’s attempts at proving that BCBSNC did not clearly communicate the network participation requirements to the plaintiff, the court said there could be no aggrievance experienced by Senderra based on its pleadings because it flat-out did not meet the terms BCBSNC laid out, and BCBSNC did not treat Senderra differently from other pharmacies.

Senderra is represented by Ellis & Winters LLP, DLA Piper, and Gardner Haas PLLC. BCBSNC is represented by Kilpatrick Townsend & Stockton LLP.