Case: 4:18-cv-01005 Doc.

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Exhibit E
 Case: 4:18-cv-01005 Doc. #: 1-5 Filed: 06/20/18 Page: 2 of 3 PageID #: 53

EXPRESS SCRIPTS ®

June 30, 2017

Sent via E-Mail to SLee@BSFLLP.com

William A Isaacson, Esq.

Boies Schiller Flexner LLP
1401 New York Avenue NW
Washington, DC 20005

Re : Response to May 17, 201 7 Lette r o n Behalf of CZ Services, Inc. d/b/a CareZone
Pharmacy, NCPDP 5654137 ("Provider")

Dear Mr. Isaacson, I

I

I
Express Scripts is in receipt your letter dated May 17, 2017 regarding Express Scripts' request to
CZ Services to cease and desist any and all mail order practice.

First, your letter states that "CZ Services is a retail pharmacy ... located in Richmond, California ...
[that] does not mail any prescriptions". A recent review of Provider's claims submitted to Express Scripts
for adjudication showed that between June 2, 2016 and June 3, 2017, a substantial portion of the
dispensed prescriptions were to members with addresses located outside of California. The following
chart has a sample of the amount of claims per state during this time period:
..
'
'
Member State Member Count Claims· Count
PA 150 3,176
OH 121 2,820
IN 124 2,725
TX 120 2 651
Ml 116 2,513
NY 133 2,442
VA 101 2,213
TN 81 1,647 -
MO 65 1,583
GA 88 1,329
FL 74 1,032
WA 52 1,022

The data clearly raises some questions and concerns regarding whether the pharmacy is mailing
prescriptions.

Second, in your letter you cite CCR.1714.1 (b) as authority for your contention that an agent of the
patient may pick up their prescription. The cited provision regulates a pharmacy's operations when a
pharmacist steps away, which does not appear to be relevant to the issues here. If there ls authority you

"? Confidential lnrormatlon

Express Scripts, Inc. One Express Way St. Louis, MO 63121 {888)571 -8182
 Case: 4:18-cv-01005 Doc. #: 1-5 Filed: 06/20/18 Page: 3 of 3 PageID #: 54

wish us to consider, please forward. Additionally, regardless of the regulations regarding agency, we
must ensure that any such practice is not being practiced in a way that circumvents the law.

In order to address these two concerns, Express Scripts requests that Provider submit signature
logs for all prescriptions filled from 5/1/2017 - 6/15/2017 that were submitted to Express Scripts for
payment. Section • of the Provider Manual states:

Section .f the Provider Manual expressly requires Provider to provide Express Scripts all -
-- - - - - - - - -
-

Based on the foregoing, Express Scripts hereby requests that Provider: (i) provide Express
Scripts with a copy of all valid Signature Logs for prescriptions dispensed from 5/1/2017 - 6/15/2017 that
were submitted to Express Scripts and (ii) refrain from any conduct that constitutes a breach of your
obligation as a participating Provider in the Express Scripts retail network(s) under the Agreement.

Provider must comply with the demands set forth above and confirm such compliance in writing
no later than July 28, 2017. In the event Provider fails to supply the requested information identified in
this letter and comply with Express Scripts' requests, Express Scripts may immediately terminate
Provider's participation in Express Scripts' provider network in accordance with the Agreement. See
Sections 4.2.b and 4.2.c of the Provider Agreement.

Please retain a copy of this letter as Provider's official correspondence. Should you have any
questions regarding this notification, please contact providercompliance@express-scripts.com.

on Riley
Senior Legal Counsel ll
Express Scripts, Inc.

Confictantlril l11fonnatlo11

Express Scripts, Inc. One Express Way St. Louis, MO 63121 {888)571-8182