Central States Southeast & Southwest Areas Health & Welfare Fund v. Merck-Medco Managed Care, L.L.C.

504 F.3d 229, 41 Employee Benefits Cas. (BNA) 2558, 2007 U.S. App. LEXIS 23090
CourtCourt of Appeals for the Second Circuit
DecidedOctober 4, 2007
DocketDocket 04-3300-cv(L), 04-3464-cv(CON), 04-3545-cv(CON), 04-3871-cv(CON)
StatusPublished
Cited by182 cases

This text of 504 F.3d 229 (Central States Southeast & Southwest Areas Health & Welfare Fund v. Merck-Medco Managed Care, L.L.C.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Second Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Central States Southeast & Southwest Areas Health & Welfare Fund v. Merck-Medco Managed Care, L.L.C., 504 F.3d 229, 41 Employee Benefits Cas. (BNA) 2558, 2007 U.S. App. LEXIS 23090 (2d Cir. 2007).

Opinion

MINER, Circuit Judge:

These appeals challenge the District Court’s approval of an amended settlement agreement (the “Settlement Agreement”) reached in a class action lawsuit brought against defendant-counter-claimant-appel-lee Merck-Medco Managed Care, L.L.C., a/k/a Medco Health Solutions, Inc., and its former parent company, Merck & Co., Inc. (collectively, “Medco”), by a plaintiff class of employee welfare benefit plans (the “Plaintiffs”). Plaintiffs, the trustees and beneficiaries of various employee welfare benefit plans, brought this action alleging that Medco breached its fiduciary duty under the Employee Retirement Income *234 Security Act of 1974 (“ERISA”) by failing to act in their best interest in its capacity as a pharmaceutical benefits manager for the plans. Movant-appellant Group Hospitalization and Medical Services, doing business as CareFirst Blue Cross Blue Shield (“CareFirst”), appealed from the judgment of the District Court denying CareFirst’s motion to intervene in the class action litigation and approving the Settlement Agreement. Movants-appellants Care-First, Central States Southeast and Southwest Areas Health and Welfare Fund (“Central States”), Sweetheart Cup Company, Inc. (“Sweetheart”), Iron Workers Tri-State Welfare Fund (“Iron Workers”), and Linda J. Cahn, Esq. (“Cahn”) (collectively, “Movants-Appellants”) all appealed from the same judgment of the District Court incorporating orders (i) certifying the instant action as a class action pursuant to Fed.R.Civ.P. 23(a) and (b)(3); (ii) approving the amended Settlement Agreement as fair, reasonable, and adequate; (iii) awarding legal fees and disbursements; and (iv) severing cases in which the ERISA plans opted out of the settlement.

On appeal, we determined that serious questions had been raised as to whether the certified representative Plaintiffs had constitutional standing to assert ERISA claims and to enter into the Settlement Agreement on behalf of the class. Cent. States Se. & Sw. Areas Health & Welfare Fund v. Merck-Medco Managed Care, L.L.C., 433 F.3d 181, 185 (2d Cir.2005). We therefore remanded to the District Court for consideration of the standing issue and retained jurisdiction pursuant to United States v. Jacobson, 15 F.3d 19 (2d Cir.1994). Cent. States, 433 F.3d at 202-04. Following remand, the District Court reviewed additional evidence submitted by the parties and concluded that Plaintiffs had established standing. Having remanded for a limited purpose, we now resume jurisdiction of this case at the parties’ request. We assume familiarity with our earlier opinion, the underlying facts, the procedural history, and the scope of issues presented on appeal, to which we refer only as necessary to explain our decision. Upon our review, we agree with the District Court that Plaintiff Marissa Jan-azzo has established standing, but we conclude that the court erred both in certifying the class without properly considering the conflicts of interest among members of the class and in approving the Settlement Agreement. We therefore vacate the judgment of the District Court and remand for further proceedings consistent with this Opinion. We affirm the judgment in all other respects.

BACKGROUND

I. ERISA Litigation and the Settlement Agreement

A. Litigation History

Plaintiffs are the trustees and beneficiaries of employee welfare benefit plans (the “Plans”) that directly or indirectly contracted with Medco to receive pharmacy benefit management services. As a pharmaceutical benefits manager (“PBM”), Medco was endowed with discretionary authority to manage certain aspects of the Plans for the primary purpose of containing pharmaceutical costs. By way of an indirect contract, insured Plans paid set premiums to their insurance companies in exchange for full payment of their beneficiaries’ prescription drugs, and the insurance companies in turn contracted with Medco for plan management services. By contrast, capitated Plans paid set premiums directly to Medco in exchange for full payment of their beneficiaries’ drugs. In the case of both the insured and capitated Plans, respectively, the insurer or Medco bore the risk of higher drug cost in paying *235 each beneficiary’s claims for prescription medications. Plans that were self-funded, however, did not pay set premiums to either an insurer or to Medco and instead paid the entire cost of the prescription drugs directly to Medco as PBM or through a third-party administrator for a fee. Accordingly, self-funded Plans alone carried the direct risk of higher drug cost.

Plaintiffs alleged in their Complaint that Medco breached its fiduciary duties to their Plans under ERISA in its capacity as PBM by (i) managing formularies — lists of preferred prescription drugs — to favor the products of its parent company, Merck & Co., Inc. (“Merck”), over competing drugs; (ii) implementing programs tending to increase the sales of Merck drugs, including by interchanging lower cost competing drugs with relatively higher cost Merck drugs; (iii) entering into drug purchase contracts with pharmaceutical manufacturers, including Merck, that included price, rebate, and discount terms that were favorable to Medco but more costly to the Plans; (iv) engaging in practices prohibited under ERISA, including the effective transfer of Plan assets to Merck through drug purchase agreements with Merck negotiated by Medco; and (v) generally failing to disclose to the Plans that it was not acting in their best interest but in the interests of Merck. Medco’s motion for summary judgment dismissing the Complaint was deferred pending discovery and later withdrawn due to settlement negotiations that culminated in the Settlement Agreement.

On July 31, 2003, the same day that it preliminarily approved the Settlement Agreement, the District Court preliminarily granted Plaintiffs’ motion for certification of the class, which included all employee welfare benefit plans that contracted with Medco, whether they were self-funded, insured, or capitated. The named plaintiffs in four of the consolidated class action cases, Genia Gruer, Walter Green, Mildred Bellow, and Elizabeth O’Hare (collectively, the “Individual Plaintiffs”), are individual Plan beneficiaries seeking derivative relief for each of their Plans and their members, as well as for all similarly situated Plans that contracted directly with Medco on a capi-tated basis or with insurers that contracted with Medco. The fifth named plaintiff, Marissa Janazzo (now Marissa Salsbury) (“Janazzo”), is a Plan trustee purporting to sue on behalf of the County Line Buick Nissan Employee Welfare Benefit Plan (the “County Line Plan”) and all similarly situated Plan trustees whose plans contracted directly with Medco or with third-party administrators or insurers that contracted with Medco. Harry J. Blumenthal Jr. and Alan Hor-witz, the named plaintiffs in a sixth ease, are Plan trustees suing on behalf of their Plan (the “Blumenthal Plan”) and on behalf of all other similarly situated Plan trustees whose Plans contracted directly with Medco.

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Bluebook (online)
504 F.3d 229, 41 Employee Benefits Cas. (BNA) 2558, 2007 U.S. App. LEXIS 23090, Counsel Stack Legal Research, https://law.counselstack.com/opinion/central-states-southeast-southwest-areas-health-welfare-fund-v-ca2-2007.