Pharmaceutical Research and Manufacturers of America v. Williams

CourtDistrict Court, D. Minnesota
DecidedMarch 15, 2021
Docket0:20-cv-01497
StatusUnknown

This text of Pharmaceutical Research and Manufacturers of America v. Williams (Pharmaceutical Research and Manufacturers of America v. Williams) is published on Counsel Stack Legal Research, covering District Court, D. Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Pharmaceutical Research and Manufacturers of America v. Williams, (mnd 2021).

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF MINNESOTA CIVIL NO. 20-1497(DSD/DTS)

Pharmaceutical Research and Manufacturers of America,

Plaintiff, v. ORDER Stuart Williams, et al., Defendants.

Joseph R. Guerra, Esq. and Sidley Austin LLP, 1501 K. Street, N.W., Washington, DC 20005, counsel for plaintiff.

Sarah L. Krans, Esq. and Minnesota Attorney General’s Office, 445 Minnesota Street, Suite 1800, St. Paul, MN, counsel for defendants.

This matter is before the court upon defendants’ motion to dismiss, plaintiff Pharmaceutical Research and Manufacturers of America’s (PhRMA) conditional motion for leave to file a supplemental complaint, and PhRMA’s motion for summary judgment. Based on a review of the file, record, and proceedings herein, and for the following reasons, defendants’ motion to dismiss is granted, PhRMA’s motion for leave to file a supplemental complaint is denied, and PhRMA’s motion for summary judgment is denied. BACKGROUND This dispute arises out of the recently enacted Alec Smith Insulin Affordability Act (Act). Compl. ¶ 1. PhRMA is a nonprofit

corporation that represents pharmaceutical companies and serves as the pharmaceutical industry’s “principal public policy advocate.” Id. ¶¶ 10, 12. Its member companies include Eli Lilly and Company (Lilly), Novo Nordisk Inc., and Sanofi, which collectively manufacture most of the insulin sold in Minnesota and the United States. Id. ¶ 13. Defendants are members of the Board of Pharmacy, named only in their official capacities, who enforce the Act.1 Id. ¶¶ 15. On April 15, 2020, the governor of Minnesota signed the Act into law to establish insulin safety net programs. Id. ¶ 64. The Act requires manufacturers to provide insulin for free to Minnesota residents who meet certain criteria. Id.; Minn. Stat. § 151.74,

subdiv. 1(a). The Act has two programs: the Continuing Safety Net Program and the Urgent Need Program. Compl. ¶ 65. The Continuing Safety Net Program mandates that manufacturers provide free insulin products to any individual who meets the

1 Defendants Stuart Williams, Stacey Jassey, Mary Phipps, Andrew Behm, James Bialke, Amy Pardis, Rabih Nahas, Samantha Schirmer, and Kendra Metz are members of the Board of Pharmacy. Compl. ¶¶ 16-24. The parties stipulated to the dismissal of defendants Nate Clark, Peter Benner, Suyapa Miranda, David Fisher, Jodi Harpstead, Phil Norrgard, Stephanie Stoffel, and Andrew Whitman, who are members of the Board of MNSure. ECF No. 22. see also Compl. ¶¶ 25-32. eligibility criteria.2 Id. Under this program, manufacturers must review applications, determine whether the applicant meets the eligibility criteria, and notify applicants of their decision

within ten business days. Id. ¶ 66; Minn. Stat. § 151.74, subdiv. 5(a). If denied, the applicant may appeal to a review panel created by the Board of Pharmacy, which may overrule manufacturers with binding decisions. Compl. ¶ 67; Minn. Stat. § 151.74, subdiv. 8. If the manufacturer determines an applicant is eligible, it next determines whether to provide the individual with a statement of eligibility. An individual with a statement of eligibility may present it to a pharmacy to obtain free insulin for up to one year. Compl. ¶¶ 68-69; Minn. Stat. § 151.74, subdiv. 5(b). If an eligible applicant does not have private insurance, the manufacturer must provide the individual with a statement of

eligibility. Compl. ¶ 69. If an eligible applicant does have

2 To be eligible, an individual must: (1) be a Minnesota resident with valid identification; (2) have a family income of 400% or less of the federal poverty level; (3) not be enrolled in medical assistance or MinnesotaCare; (4) not be eligible for federal funded healthcare or Veterans Administration prescription drug benefits; and (5) not be covered by an insurance plan under which they can obtain a thirty day supply of insulin for $75 or less out of pocket. Compl. ¶ 65; Minn. Stat. § 151.74, subdiv. 4(a)-(b). Additionally, if an individual meets some of the statutory criteria, has prescription drug coverage under Medicare Part D, and has spent more than $1000 on prescription drugs in the calendar year, they are also eligible to receive free insulin. Compl. ¶ 65, Minn. Stat. § 151.74, subdiv. 4(c). private insurance, the manufacturer may determine whether the individual’s needs are better met through the manufacturer’s co- payment assistance program. Id. ¶ 68. If it determines the

manufacturer’s assistance program better addresses the individual’s needs, the manufacturer “shall inform the individual and provide the individual with the necessary coupons to submit to a pharmacy.” Id.; Minn. Stat. § 151.74, subdiv. 5(c). Otherwise, it must provide the individual with a statement of eligibility. Compl. ¶ 68; Minn. Stat. § 151.74, subdiv. 5(b). When presented an eligibility statement, pharmacies order insulin from the manufacturer, and the manufacturer must “send to the pharmacy a 90-day supply of insulin ... at no charge to the individual or pharmacy.” Compl. ¶ 70; Minn. Stat. § 151.74, subdiv. 6(c). The pharmacy is allowed to charge the applicant a co-payment “not to exceed $50 for each 90-day supply” to cover

“the pharmacy’s costs for processing and dispensing” the insulin. Compl. ¶ 70; Minn. Stat. § 151.74, subdiv. 6(e). The manufacturer does not receive any amount of the co-payment. This process may be repeated throughout a full year of eligibility, and the manufacturer must continue to send “an additional 90-day supply of the product ... at no charge to the individual or pharmacy.” Compl. ¶ 71; Minn. Stat. § 151.74, subdiv. 6(f). The second program is the Urgent Need Program. Compl. ¶ 72. The program requires manufacturers to provide a thirty-day supply of free insulin to individuals who meet eligibility criteria.3 Id.; Minn. Stat. § 151.74, subdiv. 2(a)-(b). When an applicant submits an application with a valid prescription, the pharmacy

must dispense a thirty-day supply of insulin to the individual. Compl. ¶ 73; Minn. Stat. § 151.74, subdiv. 3(c). After dispensing insulin, the pharmacy submits a claim for payment to the manufacturer or the manufacturer’s vendor. Compl. ¶ 73; Minn. Stat. § 151.74, subdiv. 3(d). The manufacturer must either “reimburse the pharmacy in an amount that covers the pharmacy’s acquisition cost” or else “send to the pharmacy a replacement supply of the same insulin as dispensed in the amount dispensed.” Compl. ¶ 73; Minn. Stat. § 151.74, subdiv. 3(d). Pharmacies may collect an insulin co-payment form from the individual in an amount not to exceed thirty-five dollars for the thirty-day supply. Compl. ¶ 74; Minn. Stat. § 151.74, subdiv.

3(e). The manufacturer does not receive any of the co-payment amount. Compl. ¶ 74.

3 Eligible individuals must (1) be Minnesota residents who are not enrolled in Medicaid or MinnesotaCare; (2) not be enrolled in a prescription drug coverage plan that would cover thirty-day supply of insulin for $75 or less out of pocket; (3) not have received insulin under the Urgent Need Program within the last twelve months; and (4) have less than a seven-day supply of insulin and need insulin to avoid the likelihood of suffering significant health consequences. Compl. ¶ 72; Minn. Stat. § 151.74, subdiv. 2(a)-(b). PhRMA claims it will incur significant expenses by giving away free insulin and administering both programs. Id. ¶ 75. Moreover, if a manufacturer does not comply with the programs and

other statutory requirements, the Board of MNSure may assess penalties. Id. ¶ 76; Minn. Stat. § 151.74, subdiv. 10(a)-(b). The Act governs all insulin manufacturers unless one of two exceptions applies. Compl. ¶ 77. First, manufacturers with an “annual gross revenue of $2,000,000 or less from insulin sales in Minnesota” are exempt under the Act. Id.; Minn. Stat. § 151.74, subdiv. 1(c).

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