The Humana world headquarters building in downtown Louisville, Kentucky. Humana's RICO Claims Against MS Drug Manufacturer Barred by 'Indirect Purchaser' Rule, Judge Concludes
"Under the 'indirect purchaser rule,' first developed by the Supreme Court in the antitrust context, only a direct purchaser of goods has standing to assert a claim for violation of the antitrust laws," U.S. District Judge F. Dennis Saylor wrote. "Every circuit to have considered the issue has held that the rule also applies to civil RICO actions, and that indirect purchasers therefore do not have standing to assert RICO claims. The First Circuit has not yet addressed the question. While there may be practical and policy reasons to question the application of that rule in the health-insurance context, for the reasons that follow, this Court will follow the majority rule. It will therefore dismiss the civil RICO claims for failure to state a claim on that basis."
April 11, 2023 at 10:16 AM
6 minute read
A federal judge in Massachusetts recently dismissed a case brought by Humana insurance accusing a drug manufacturer Biogen of making unlawful donations to different charities to help fund patient copays of its multiple sclerosis drugs to increase its number of prescriptions and sales.
In September 2021, Humana filed a complaint that claimed Biogen developed a scheme to lure Medicare and its insurers to overpay for Tysabri, Avonex, and Tecfidera, which cost about $50,000 to $80,000 per year. Biogen allegedly "seeded" the market by giving away free medication to patents who lacked insurance coverage and then began "sweeping" patients from its free-drug program into Medicare or other government-funded healthcare programs and then funneling illegal copayment assistance to those same patients under the guise of unrestricted charitable giving, according to the complaint.
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