Company Website:
http://krcomplexlit.com/
SEATTLE -- (Business Wire)
Attorney Advertising. On March 17, 2017, the nationally
recognized class-action law firm of Keller
Rohrback L.L.P. filed suit against the nation’s three largest
pharmacy benefit managers (“PBMs”), Express Scripts (ESRX:US), OptumRx
(UNH:US), and CVS Caremark (CVS:US), and the three major insulin
manufacturers, Sanofi-Aventis (SNY:US), Novo Nordisk (NVO:US), and Eli
Lilly (LLY:US), who produce the well-known and widely-prescribed analog
insulins: Lantus, Apidra, Levemir, Humalog, and Novolog. The complaint,
which was filed in the New Jersey federal district court, alleges that
the PBMs—insurance industry middlemen who negotiate drug prices and
create drug formularies that determine how much patients pay—conspired
with the insulin manufacturers to artificially inflate the price of
insulin for their own collective benefit. This profit-seeking move has
directly injured individual patients and other purchasers of insulin
financially and put the lives of millions of diabetes sufferers at risk.
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Keller Rohrback L.L.P. filed suit against the nation's three largest pharmacy benefit managers and the three major insulin manufacturers, who produce the well-known and widely-prescribed analog insulins. (Photo: Business Wire)
The Plaintiffs in Keller Rohrback’s case—Boss v. CVS Health Corp. et
al., No. 17-cv-01823 (D.N.J.)—are individuals who purchase insulin
for themselves or their children, and the Type 1 Diabetes Defense
Foundation, a nonprofit organization dedicated to promoting the social
welfare and protecting the legal rights of individuals who must take
insulin to survive. Together these Plaintiffs bring a perspective
arising from their own personal experiences and the foundation’s
organizational purpose. And their case is focused holistically on the
problem, the responsible parties, and the breadth of injury to insulin
purchasers. Thus, their complaint includes defendant parties not
included and/or claims that have not yet been asserted in two other
recently filed cases.
The artificially high cost of insulin needlessly inflicts physical,
emotional, and financial harm on patients and their families. While
insulin manufacturers certainly contribute to the problem, they do not
act alone. Rather, manufacturers collude with PBMs to raise insulin
“list prices”—which the PBMs direct consumers to pay—thus reaping
outsized profits from people who need insulin to stay alive.
The Insulin Pricing Scheme alleged in Plaintiffs’ complaint explains how
PBMs sell exclusionary or preferential access to their formularies in
exchange for a cut of rebates and other fees paid by the drug
manufacturers to the PBMs. Formularies are ranked lists of drugs that
health insurers rely upon to determine how much of their members’ drug
costs they will cover. Manufacturers’ sales depend on access to these
enormous purchaser pools for their profits. Although the PBMs claim the
rebates and other payments lower the cost of insulin, in fact,
this is misleading. The rebates and other payments decrease the cost of
insulin for the PBMs and the insurers with whom the rebates are shared,
but drive up the cost for consumers, whose pre-deductible or coinsurance
payments at the pharmacy point-of-sale are based on the unrebated “list”
price.
The PBMs and manufacturers game the system. Instead of competing on
price for access to the PBMs’ formularies, the manufacturers compete
based on the amount of the rebate and other fees that they pay to the
PBMs. To prevent the rebates and other fees—and the wasteful
transactional costs created by an increasingly convoluted system of
payments—from cutting into their profits, the manufacturers raise what
they call the “list” price of insulin.
Meanwhile, considerable rebates to PBMs maintain at a steady point the
“net” price actually realized by the manufacturers. The higher the
“list” price, the higher the rebate and other fees, and the larger the
profit to the PBMs. The result is a vicious cycle of “list” price
increases by manufacturers, vying to win the favor of the PBMs.
Consumers with out-of-pocket payment obligations, a large and growing
population, are charged an amount based upon the artificially inflated
“list” price. This includes the uninsured and people in a variety of
types of health plans with co-insurance, co-payment, and high-deductible
requirements.
Plaintiffs hired Keller Rohrback not only to make sure the PBMs are held
accountable for their role in driving up insulin prices, but also to
ensure that all types of plan participants are represented and their
claims asserted. For example, the scheme affects participants in both
ACA and employer-sponsored plans. Most employer-sponsored welfare
benefit plans are governed by the Employee Retirement Income Security
Act of 1974 (“ERISA”)—which is why Plaintiffs in this action have
pleaded claims under ERISA in addition to the other federal claims
available to the ERISA Class under the Racketeer Influenced and Corrupt
Organizations Act (“RICO”) and the Sherman antitrust act. Plaintiffs
also have asserted claims on behalf of the uninsured, a Medicare Class,
and a class of ACA and state exchange, private, and employer plans that
are not covered by ERISA. This class structure is significant because it
aligns the injured parties with the types of plans they have and the
types of claims they can assert, including state consumer protection
laws and common law claims for non-ERISA plans and the uninsured.
Finally, Plaintiffs’ complaint seeks both monetary and injunctive relief
on behalf of the Classes. As in two other recently filed insulin cases,
Plaintiffs are requesting remedies that would refund their overpayments
and force Defendants to disgorge their ill-gotten gains. Critically, the
injunctive relief that is unique to the Boss case would impose
disclosure requirements going forward that will increase transparency in
a market where a hidden dual pricing system has driven insulin prices
through the roof—at severe financial and physical costs to users and
purchasers of insulin. Disclosure of this information will make it more
difficult for the Defendants to manipulate the cost of insulin in the
future, should they attempt to replace the current system with some
other scheme.
Keller
Rohrback looks forward to litigating this case and working with the
other plaintiffs and their counsel who have filed similar cases to hold
all responsible entities accountable and pursue all available claims.
Keller Rohrback L.L.P. has decades of experience helping consumers and
insureds fight back against fraud and abuse. Keller Rohrback L.L.P.
serves as lead and co-lead counsel in class action lawsuits throughout
the country, including actions asserting RICO, ERISA, and consumer
claims against PBMs. With offices in New York, Seattle, Phoenix, Ronan,
Oakland, and Santa Barbara, our Complex Litigation Group is proud to
offer its expertise to clients nationwide. Our trial lawyers have
obtained judgments and settlements on behalf of clients in excess of
eighteen billion dollars.
If you purchase prescription insulin produced by any of the above-listed
manufacturers, you may be paying artificially inflated and
anti-competitive prices. Please contact an attorney to learn more about
whether you too have been subject to unlawful pricing. Call 800.776.6044
or email consumer@kellerrohrback.com.
Attorney Advertising. Prior results do not guarantee a similar
outcome. Not licensed to practice law in all states. Please refer to our
website for details.
View source version on businesswire.com: http://www.businesswire.com/news/home/20170325005007/en/
Contacts:
Keller Rohrback L.L.P.
Gretchen
Obrist and Derek
Loeser, Attorneys
1201 Third Avenue, Suite 3200
Seattle,
WA 98101
800-776-6044
consumer@kellerrohrback.com
http://www.krcomplexlit.com
Source: Keller Rohrback L.L.P.
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