Mosaic Health, Inc. and Central Virginia Health Services, Inc., individually and on behalf of all those similarly situated v. Sanofi-Aventis U.S., LLC, Eli Lilly and Company, Lilly USA, LLC, Novo Nordisk Inc., and AstraZeneca Pharmaceuticals LP

CourtDistrict Court, W.D. New York
DecidedJune 26, 2026
Docket6:21-cv-06507
StatusUnknown

This text of Mosaic Health, Inc. and Central Virginia Health Services, Inc., individually and on behalf of all those similarly situated v. Sanofi-Aventis U.S., LLC, Eli Lilly and Company, Lilly USA, LLC, Novo Nordisk Inc., and AstraZeneca Pharmaceuticals LP (Mosaic Health, Inc. and Central Virginia Health Services, Inc., individually and on behalf of all those similarly situated v. Sanofi-Aventis U.S., LLC, Eli Lilly and Company, Lilly USA, LLC, Novo Nordisk Inc., and AstraZeneca Pharmaceuticals LP) is published on Counsel Stack Legal Research, covering District Court, W.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Mosaic Health, Inc. and Central Virginia Health Services, Inc., individually and on behalf of all those similarly situated v. Sanofi-Aventis U.S., LLC, Eli Lilly and Company, Lilly USA, LLC, Novo Nordisk Inc., and AstraZeneca Pharmaceuticals LP, (W.D.N.Y. 2026).

Opinion

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF NEW YORK _____________________________________

MOSAIC HEALTH, INC. and CENTRAL VIRGINIA HEALTH SERVICES, INC., individually and on behalf of all those similarly situated, DECISION AND ORDER Plaintiffs, 6:21-CV-06507 EAW CDH v.

SANOFI-AVENTIS U.S., LLC, ELI LILLY AND COMPANY, LILLY USA, LLC, NOVO NORDISK INC., and ASTRAZENECA PHARMACEUTICALS LP,

Defendants. _____________________________________

INTRODUCTION In this putative class action, plaintiffs Mosaic Health, Inc. (“Mosaic Health”) and Central Virginia Health Services, Inc. (“CVHS”) (collectively “Plaintiffs”) allege that defendant pharmaceutical companies Sanofi-Aventis U.S., LLC (“Sanofi”), Eli Lilly and Company and Lilly USA, LLC (“Eli Lilly”), Novo Nordisk Inc. (“Novo Nordisk”), and AstraZeneca Pharmaceuticals LP (“AstraZeneca”) (collectively “Defendants”) have violated state and federal antitrust laws by “coordinating to retract a long-standing discount for safety-net hospitals and clinics.” (Dkt. 93 at ¶ 1). Plaintiffs have also asserted claims for unjust enrichment under the laws of several states. (Id. at ¶¶ 388-480). Defendants have moved for dismissal of Plaintiffs’ state-law antitrust and unjust enrichment claims. (Dkt. 113). For the reasons that follow, Defendants’ motion is granted in part and denied in part.

BACKGROUND I. Factual Background The facts that follow are taken from the second amended complaint, which is the operative pleading. (Dkt. 93). Consistent with the standard on a motion to dismiss, the Court treats Plaintiffs’ allegations as true. This case involves “a special discount offered to safety-net hospitals and clinics, which purchase drugs filled by their patients at retail pharmacies.” (Id. at ¶ 3). This

discount is “known as the 340B Drug Discount,” because it “is calculated by a mathematical formula codified at Section 340B of the Public Health Service Act, 42 U.S.C. § 256b.” (Id.). For a number of years, pharmaceutical companies “offered the 340B Drug Discount to safety-net hospitals and clinics, not only for on-site use but also for purchase and distribution by retail pharmacies.” (Id.). These retail pharmacies, which are typically called “Contract Pharmacies,” have contracts with

safety-net providers pursuant to which the providers “purchase drugs on their own accounts, discounted with the 340B Drug Discount, to be delivered to and dispensed by the Contract Pharmacies.” (Id.). “Since at least 1996, and in greater volumes since 2010, all drug companies participating in the 340B Drug Discount Program have offered Contract Pharmacy 340B Drug Discounts to covered entities.” (Id. at ¶ 57). Plaintiffs and the members of the putative class are “safety-net hospitals and clinics” that “provide healthcare services to low-income and underserved patients[.]” (Id. at ¶ 5). These services are funded in significant part through savings derived

from 340B Drug Discounts. (Id.). “The net savings and revenue generated through access to 340B Drug Discounts is sometimes referred to as 340B Savings.” (Id. at ¶ 25). Defendants “are four drug companies that dominate three key markets for diabetes treatments”—specifically, the “lucrative diabetes markets for: (i) rapid- acting analog insulins; (ii) long-acting analog insulins; and (iii) incretin mimetics.” (Id. at ¶ 2). Plaintiffs contend that in the summer of 2020—following the failure of a

joint lobbying effort by Defendants to limit 340B Drug Discounts with respect to diabetes medications—Defendants entered into a conspiracy to “collusively eliminat[e] or limit[] Contract Pharmacy 340B Drug Discounts for their drugs, most significantly including their drugs dominating rapid-acting analog insulin, long- acting analog insulin, and incretin mimetic sales.” (Id. at ¶ 6). In the second half of 2020, each of Defendants “announced novel restrictions

on Contract Pharmacy 340B Drug Discounts.” (Id. at ¶ 133). On July 24, 2020, AstraZeneca informed the Department of Health and Human Services (“HHS”) by letter that beginning on October 1, 2020, it would recognize only one contract pharmacy per covered entity for covered entities without an on-site dispensing pharmacy. (Id. at ¶ 134). On July 27, 2020, Sanofi publicly announced that it was implementing a new initiative that “would cut off all Contract Pharmacy 340B Drug Discounts, which had been in place for a decade, unless covered entities . . . ent[ered] into a contract to provide sensitive prescription claims data to a Sanofi vendor, Second Sight Solutions, through a software portal called 340B ESP” on what

Plaintiffs contend were “commercially unreasonable terms[.]” (Id. at ¶ 136). On August 19, 2020, Eli Lilly advised HHS by letter that effective September 1, 2020, it would end its practice of “honoring requests for 340B contract pharmacies for orders on all Lilly products except where, primarily, a covered entity does not have an in-house pharmacy.” (Id. at ¶ 137) (internal quotation marks omitted). Eli Lilly “added a special exception to permit Contract Pharmacies to pass along certain insulin products at cost,” but Plaintiffs assert that this “exception was infeasible for

covered entities and pharmacies, as it required the Contract Pharmacies to fill prescriptions without any fee whatsoever.” (Id. at ¶ 138). On December 1, 2020, Novo Nordisk informed HHS that “it would stop offering Contract Pharmacy 340B Drug Discounts to hospital covered entities” effective January 1, 2021. (Id. at ¶ 140). Defendants “have since made minor changes to their exceptions, while maintaining their common approach of refusing to offer Contract

Pharmacy 340B Drug Discounts for the overwhelming majority of potential Contract Pharmacy sales.” (Id. at ¶ 141). Defendants’ newly adopted restrictions had the “immediate impact” of ending “the overwhelming majority of Contract Pharmacy 340B Drug Discount sales to covered entities.” (Id. at ¶ 177). II. Procedural Background Mosaic Health commenced this matter on July 30, 2021. (Dkt. 1). CVHS was added as a plaintiff in the first amended complaint, which was filed on October 22,

2021. (Dkt. 41). Defendants filed a joint motion to dismiss the first amended complaint on November 12, 2021. (Dkt. 47; Dkt. 48). The Court granted Defendants’ motion on September 2, 2022, but afforded Plaintiffs the opportunity to file a motion for leave to amend. (Dkt. 71). On October 3, 2022, Plaintiffs filed a motion for leave to amend. (Dkt. 72). The Court denied Plaintiffs’ motion on February 1, 2024, and ordered that the Clerk of Court close the case. (Dkt. 83). Plaintiffs appealed the dismissal of the action. (Dkt.

85). The Second Circuit subsequently vacated the judgment and remanded the matter for this Court to grant Plaintiffs leave to file their second amended complaint and to re-examine its conclusions as to Plaintiffs’ state-law claims. Mosaic Health, Inc. v. Sanofi-Aventis U.S., LLC, 156 F.4th 68, 85 (2d Cir. 2025). The Second Circuit’s mandate issued on December 15, 2025. (Dkt. 87). The second amended complaint was filed on December 17, 2025 (Dkt. 93),and

sets forth the following claims: (1) violations of § 1 of the Sherman Act, 15 U.S.C.

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Mosaic Health, Inc. and Central Virginia Health Services, Inc., individually and on behalf of all those similarly situated v. Sanofi-Aventis U.S., LLC, Eli Lilly and Company, Lilly USA, LLC, Novo Nordisk Inc., and AstraZeneca Pharmaceuticals LP, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mosaic-health-inc-and-central-virginia-health-services-inc-nywd-2026.