County of Suffolk v. Abbott Laboratories

339 F. Supp. 2d 165
CourtDistrict Court, D. Massachusetts
DecidedSeptember 30, 2004
DocketNo. MDL 1456; No. CIV.A.01-12257-PBS
StatusPublished
Cited by1 cases

This text of 339 F. Supp. 2d 165 (County of Suffolk v. Abbott Laboratories) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
County of Suffolk v. Abbott Laboratories, 339 F. Supp. 2d 165 (D. Mass. 2004).

Opinion

MEMORANDUM AND ORDER

SARIS, District Judge.

I. INTRODUCTION

Defendants have moved to dismiss the Amended Complaint filed by the County of Suffolk in New York in this multi-district litigation involving allegations of fraud against various pharmaceutical companies.1 Suffolk alleges that Defendant pharmaceutical manufacturers have fraudulently inflated the published average wholesale prices (“AWP’s”) of their drugs, and that these fraudulent AWP’s have caused the State' to overpay retail pharmacists for Medicaid drugs. Because New York bills the County for twenty-five percent of the State’s Medicaid expenditures, the County claims it has been harmed by the fraudulent drug pricing. Suffolk also alleges that Defendants filed false “Best Prices” reports with the federal government, thereby reducing the rebates paid by the pharmaceutical manufacturers to the State and, consequentially, from the State to Suffolk. Suffolk has asserted federal racketeering claims under 18 U.S.C. § 1962(c), a claim for breach of contract as a third-party beneficiary of the contract between the federal government and each Defendant, an implied cause of action under the federal Best Prices statute, 42 U.S.C. § 1396r-8, as well as six claims under various state law theories.2

Pointing out that Suffolk is only one of fifty-eight counties in New York State and that New York State itself has sued several manufacturers, Defendants collectively argue that Suffolk, as an indirect purchaser of the Medicaid drugs, has no standing to sue because its claim is entirely derivative of the State’s, that counties are not third-party beneficiaries of the Best Prices [174]*174contracts, and that the other claims fail substantively and under Federal Rule of Civil Procedure 9(b).

After hearing and review of the briefs, the Court ALLOWS the motion to dismiss Counts I, II, VI, and VIII and DENIES the remainder of the motion, subject to a forthcoming opinion addressing the issues raised in the individual briefs of twenty-two Defendants.

II. BACKGROUND

The Court assumes close familiarity with the discussion of the alleged AWP scheme in its prior opinions, which set forth the factual background of the allegations as well as the appropriate legal standards. See, e.g., In re Pharm. Indus. Average Wholesale Price Litig., 263 F.Supp.2d 172 (D.Mass. May 13, 2003) (Saris, J.) (“Pharm.I ”); In re Pharm. Indus. Average Wholesale Price Litig., 309 F.Supp.2d 165 (D.Mass. Jan.9, 2004) (Saris, J.) (“Pharm.II ”); In re Pharm. Indus. Average Wholesale Price Litig., 307 F.Supp.2d 190 (D.Mass. Jan.9, 2004) (Saris, J.) (“PharmJII ”); In re Pharm. Indus. Average Wholesale Price Litig., 307 F.Supp.2d 196 (D.Mass. Feb.24, 2004) (Saris, J.) (“Pharm.IV”); In re Pharm. Indus. Average Wholesale Price Litig., 321 F.Supp.2d 187 (D.Mass. June 10, 2004) (“Pharm.V”). The details of this particular dispute involve aspects of New York’s Medicaid system.

In New York, the State reimburses providers directly for pharmaceuticals under its Medicaid system, N.Y. Soc. Serv. L. § 367-b (McKinney 2004) (transferring payment responsibility from localities to State), and bills each county for twenty-five percent of the costs associated with the citizens of that county (Am. Compl. at ¶¶ 1, 315 (citing N.Y. Soc. Serv. L. § 368-a (McKinney 2004))).3 Under the New York Medicaid statute, physician-administered drugs are billed by the physician at “the actual cost of the drugs to practitioners.” N.Y. Soc. Serv. L. § 367-a(9)(a). Pharmacist-provided drugs for which no upper limit has been set by the federal Centers for Medicare & Medicaid Services (formerly known as the Health Care Financing Administration) that are either multiple source prescription drugs (i.e., generic drugs) or brand name prescription drugs are reimbursed at the lower of the providers’ usual and customary charge to the general public or the Estimated Acquisition Cost (“EAC”) of the drug, plus a reasonable dispensing fee. N.Y. Soc. Serv. L. § 367-a(9)(b). Estimated Acquisition Cost is defined as “the average wholesale price of a prescription drug ... as reported by the prescription drug pricing service used by the department, less twelve percent ... ,”4 Id. Suffolk alleges that New York law defines “average wholesale price” for multi-source drugs or biologicals as “equal to the lessor of the median AWP for all of the generic forms of the drug or biological, or the lowest brand name product AWP.” (Am. Compl. at ¶ 95.) As a practical matter, “usual and customary” charge data is impossible to obtain, so [175]*175reimbursement for drugs usually is based on the EAC of a drug, which in turn is based on the inflated AWP of that drug less the percentage discount. (Am. Compl. at ¶¶ 71-73.)

New York is a participant in the federal “Best Prices” program, under which pharmaceutical manufacturers pay rebates to the states pursuant to rebate agreements between each manufacturer and the Secretary of Health and Human Services. (Am. Compl. at ¶¶ 8, 76-80.) See also 42 U.S.C. § 1396r-8 (establishing Best Prices program); Pharm. V, 321 F.Supp.2d at 195— 97 (describing Best Prices program).

Suffolk claims that while the passage of Section 367-b in 1978 centralized administrative control over the claims paying process, counties (called, along with certain cities, “social services districts”) still routinely play a role in recovering Medicaid overpayments. (Opp. at 10 n. 9.) Several public welfare statutes explicitly empower counties to file suits for the cost of medical treatment in certain situations. See, e.g., N.Y. Soc. Serv. L. § 104-b (McKinney 2004) (authorizing county to file a lien on personal injury recovery of person receiving public assistance); N.Y. Soc. Serv. L. § 369 (McKinney 2004) (allowing county to file lien on interest in trust to recover cost of medical assistance). Additionally, New York Social Services Law Section 145-b grants counties as well as the State the right to recover treble damages for false statements made to obtain payments from public funds authorized under the chapter of the New York statutes concerning “Assistance and Care.” N.Y. Soc. Serv. L. § 145-b (McKinney 2004).

III. DISCUSSION

A. RICO

Suffolk pleads manufacturer-publisher enterprises similar to those dismissed from the Amended Master Consolidated Complaint (“AMCC”) action in Pharm. IV, 307 F.Supp.2d at 203-05. In one paragraph, however, Suffolk’s pleading differs from the AMCC, in that publishers are alleged to play more of a role in setting AWP’s. Rather than simply listing AWP’s reported to them by manufacturers, publishers receive “WACs [Wholesale Acquisition Cost Data] that are converted to AWPs.” (Am. Compl. at ¶ 81.) This account is consistent with descriptions in recent briefs submitted by the plaintiffs in the AMCC action.

However, Suffolk does not plead this fact in relation to the RICO count (see Am.

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Related

In Re Pharm. Industry Average Wholesale Price Litigation
339 F. Supp. 2d 165 (D. Massachusetts, 2004)

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339 F. Supp. 2d 165, Counsel Stack Legal Research, https://law.counselstack.com/opinion/county-of-suffolk-v-abbott-laboratories-mad-2004.