Johnson v. OptumRx, Inc. et al.
United States District Court for the Central District of California
Case No. 17-07198 (BRM)(LHG)
On May 23, 2017, the nationally recognized class-action law firm of Keller Rohrback L.L.P. filed suit against one the nation’s largest pharmacy benefit managers (“PBMs”), OptumRx, and one of the major manufacturers of the incretin-mimicking medications, Novo Nordisk, who produces the well-known and widely-prescribed medication Victoza. The complaint, which was filed in the Central District of California federal court, alleges that OptumRx—an insurance industry middleman who negotiates drug prices and creates drug formularies that determine how much patients pay—conspired with Novo Nordisk to artificially inflate the price of Victoza for their collective benefit. This profiteering has directly injured individual patients and other purchasers of Victoza financially and put the lives of millions of diabetes sufferers at risk.
Victoza Pricing Scheme Explained
The Victoza 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 Victoza, in fact, this is misleading. The rebates and other payments decrease the cost of Victoza 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 Victoza. In fact, over the past three years, the “list” price for incretin memetic drugs have increased from anywhere between 28-68%.
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’ complaint seeks both monetary and injunctive relief on behalf of a Class of consumers who purchased Victoza. Plaintiffs are requesting remedies that would refund their overpayments and force Defendants to disgorge their ill-gotten gains. Critically, the injunctive relief that is being sought in this case would impose disclosure requirements going forward that will increase transparency in a market where a hidden dual pricing system has driven Victoza pricing through the roof—at severe financial and physical costs to users and purchasers of Victoza. Disclosure of this information will make it more difficult for the Defendants to manipulate the cost of Victoza in the future, should they attempt to replace the current system with some other scheme.
If you purchase prescription Victoza produced by Novo Nordisk, or any other incretin mimetic drugs like Bydureon, Byetta, Tanzeum or Trulicity, 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 email@example.com.
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