Massachusetts v. Schering-Plough Corp.

779 F. Supp. 2d 224, 2011 U.S. Dist. LEXIS 46293, 2011 WL 1575198
CourtDistrict Court, D. Massachusetts
DecidedApril 27, 2011
DocketCivil Action 03-11865-PBS
StatusPublished
Cited by13 cases

This text of 779 F. Supp. 2d 224 (Massachusetts v. Schering-Plough Corp.) 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
Massachusetts v. Schering-Plough Corp., 779 F. Supp. 2d 224, 2011 U.S. Dist. LEXIS 46293, 2011 WL 1575198 (D. Mass. 2011).

Opinion

MEMORANDUM AND ORDER

SARIS, District Judge.

I. INTRODUCTION

The Commonwealth of Massachusetts claims that Schering-Plough Corporation, Sehering Corporation, and Warrick Pharmaceuticals Corporation caused the Massachusetts Medicaid Program to overpay for the generic drug Albuterol by fraudulently inflating the “Wholesale Acquisition Cost” (“WAC”) of the drug. The Commonwealth argues that the spreads between defendants’ reported prices and “true” WACs ranged from 100% to 700%. Albuterol is a drug used to prevent and treat respiratory problems caused by lung diseases such as asthma.

After a lengthy trial, the jury returned a verdict in favor of the Commonwealth, finding that defendants committed fraud and violated the Massachusetts False Claims Act (“MFCA”) and the Massachusetts Medicaid False Claims Act (“MMFCA”), causing the Commonwealth damages in the amount of $4,563,328. (See Jury Verdict, Docket No. 934.) Both sides have filed post-trial motions. Defendants seek judgment as a matter of law in their favor or, alternatively, a new trial. (Docket No. 936.) The Commonwealth seeks entry of judgment in its favor, along with trebled damages and an award of civil penalties. (Docket No. 946.) In addition, the parties agreed during trial that the Commonwealth’s claim of breach of the implied covenant of good faith and fair dealing could be resolved by the Court as a matter of law based upon the jury’s findings on the other counts. Accordingly, the Court must rule on that outstanding claim.

After a hearing and a review of the record, the Court ALLOWS defendants’ motion for judgment as a matter of law to the extent it pertains to Prong 1 of the *227 Massachusetts False Claims Act and to the claim of breach of the implied covenant of good faith and fair dealing. The Court also finds that application of the Massachusetts False Claims Act to conduct that occurred prior to the MFCA’s passage in July 2000 would be impermissibly retroactive. This Court DENIES the remainder of defendants’ motion. The Court ALLOWS the Commonwealth’s motion for entry of judgment in its favor on the jury’s verdict (with the exception of the verdict on Prong 1 of the MFCA), but DENIES the motion as it pertains to breach of the implied covenant of good faith and fair dealing.

II. FACTUAL BACKGROUND

The Court assumes familiarity with the drug pricing issues discussed in its previous decisions in this case and in the related multi-district litigation. See Massachusetts v. Mylan Labs., Inc., 608 F.Supp.2d 127 (D.Mass.2008); Massachusetts v. Mylan Labs., Inc., 357 F.Supp.2d 314 (D.Mass.2005); see also In re Pharm. Indus. Average Wholesale Price Litig., 685 F.Supp.2d 186 (D.Mass.2010); In re Pharm. Indus. Average Wholesale Price Litig., 478 F.Supp.2d 164 (D.Mass.2007); In re Pharm. Indus. Average Wholesale Price Litig., 460 F.Supp.2d 277 (D.Mass.2006).

The facts below are found in the trial record, and are recited in the light most favorable to the verdict. See Grajales-Romero v. Am. Airlines, 194 F.3d 288, 292 (1st Cir.1999).

A. MassHealth

The Massachusetts Medicaid Program, MassHealth, is a means-tested government entitlement program, jointly financed by the federal and state governments, that provides healthcare to low-income residents in Massachusetts. MassHealth covers 1.2 million people in the Commonwealth.

MassHealth uses a pricing algorithm to reimburse pharmacies for prescription drugs dispensed to members. The algorithm reimburses based on the lowest of four calculations: (1) the Federal Upper Limit (“FUL”) set by the federal government; (2) the Massachusetts Upper Limit Price (“MULP”) set by the Commonwealth; (3) the Estimated Acquisition Cost (“EAC”), defined as a price generally paid by providers to wholesalers and estimated using WAC + 10% 1 ; and (4) the Usual and Customary price (“U & C”), which is determined by the “billed amount” reported by the pharmacy submitting the claim. The algorithm identifies which of the four prices is the lowest and adds a dispensing fee to determine the “allowed amount” that MassHealth will reimburse the pharmacist for prescription drug sales to MassHealth beneficiaries.

B. Schering-Plough Corporation

At all relevant times, defendant Schering-Plough was a publically-traded pharmaceutical holding ‘company headquartered in New Jersey. It had no employees, but owned various subsidiary corporations, including defendant Schering. Schering is wholly owned by Schering-Plough and is its principal operating subsidiary. It engages in the manufacture and sale of brand-name pharmaceutical products. (Trial Exhibit (“TX”) 2.) In 1993, defendant Warrick was incorporated as a wholly-owned subsidiary of Schering. Its function was *228 to act a generic pharmaceutical manufacturer. Warrick was designed to “[p]rotect and extend the life cycle of [Schering’s] branded products as patents expire” and “create leverage in our Managed Care business,” through bundling brand and generic products. (TX 12.)

On November 3, 2009, Schering-Plough merged with Merck & Co, Inc. to form the world’s second-largest pharmaceutical company. (TX 2.)

C. Warrick’s Pricing Conduct

During the mid-1990s, Schering’s largest-selling drug was Proventil, a brand-name version of the drug albuterol that is used to treat asthma and other respiratory diseases. Patent protection for Proventil expired in late 1995. In order to prevent deterioration of albuterol sales after the launch of generic competition, Schering set up Warrick Pharmaceuticals to sell generic versions of Proventil. At issue in this case are three Warrick drugs: Albuterol Sulfate (.083%), Albuterol Sulfate (.5%), and an Albuterol inhaler (90 meg).

In December 1995, prior to launching its albuterol inhaler as a generic product, Warrick sent letters to various customers, including MassHealth, announcing the product’s launch and listing its launch price as $16.06 per unit of the inhaler. This price is described as the “direct wholesale” price. The letter written to MassHealth explained that “[t]his information is being provided in the event it is required for reimbursement purposes.” (TX 8.) The $16.06 direct wholesale price was also provided to First DataBank, a company that publishes pharmaceutical pricing information. First DataBank published this direct wholesale price in its WAC field.

Warrick expected that this initial launch price would drop and provided “price protection” for its wholesale and retail pharmacy customers, meaning that if they purchased albuterol at $16.06 per unit and the price later fell, they would receive a rebate. Within six months, the price for the albuterol inhaler had fallen to $12 for all major wholesalers, and by May 2000 the price fell to $5.00 or less. Warrick did not report these price changes to MassHealth or to First DataBank.

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779 F. Supp. 2d 224, 2011 U.S. Dist. LEXIS 46293, 2011 WL 1575198, Counsel Stack Legal Research, https://law.counselstack.com/opinion/massachusetts-v-schering-plough-corp-mad-2011.