United States Ex Rel. Foster v. Bristol-Myers Squibb Co.

587 F. Supp. 2d 805, 71 Fed. R. Serv. 3d 952, 2008 U.S. Dist. LEXIS 73090, 2008 WL 4360697
CourtDistrict Court, E.D. Texas
DecidedSeptember 24, 2008
Docket2:05-cv-00084
StatusPublished
Cited by16 cases

This text of 587 F. Supp. 2d 805 (United States Ex Rel. Foster v. Bristol-Myers Squibb Co.) is published on Counsel Stack Legal Research, covering District Court, E.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States Ex Rel. Foster v. Bristol-Myers Squibb Co., 587 F. Supp. 2d 805, 71 Fed. R. Serv. 3d 952, 2008 U.S. Dist. LEXIS 73090, 2008 WL 4360697 (E.D. Tex. 2008).

Opinion

MEMORANDUM OPINION AND ORDER

THAD HEARTFIELD, District Judge.

Before the Court is Defendant’s Motion to Dismiss Relator’s Complaint and Mem *808 orandum of Points and Authorities in Support [Clerk’s Docket No. 22], filed December 13, 2007. Having considered the motion, the responsive briefs, the record and the applicable law, the Court enters the following order.

I. Factual & Procedural Background

Relator John David Foster (“Relator” or “Foster”) brings this qui tam action against Defendant Bristol-Myers Squibb Company (“Defendant” or “BMS”), alleging violations of the Federal False Claims Act 1 (the “FCA”) and similar state statutes. 2 In plain terms, Foster accuses BMS of (1) giving illegal bribes and kickbacks to an HMO in order to induce doctors to prescribe BMS drugs; and (2) reporting inflated prices for those drugs to in order to avoid paying Medicaid rebates to the government.

A. The Factual Basis of Foster’s Claims

Foster previously worked for one of BMS’s competitors: the pharmaceutical company Parke-Davis. Foster was Parke-Davis’s National Account Manager for accounts in Texas and Louisiana from June 1998 through September 2000. In this position, he was responsible for selling pharmaceutical products to health maintenance organizations (“HMOs”) and other managed care entities. One such HMO was the Oschner Health Plan (“OHP”), which operated in Louisiana and the Eastern District of Texas. OHP was a large regional HMO, with approximately 200,000 individual members and some 700 affiliated doctors. One of Foster’s tasks at Parke-Davis was convincing OHP to give unrestricted formulary access to Parke-Davis’s cholesterol-lowering drug, Lipitor.

For the uninitiated, a formulary is a list of medications for which an HMO provides coverage. J.B.D.L. Corp. v. Wyeth-Ayerst Laboratories, Inc., 485 F.3d 880, 884 (6th Cir.2007). Formularies come in a variety of shapes and sizes. Id. An HMO with an “open formulary” structure will pay for drugs not listed on the formulary; one with a “closed formulary” will not. Id. Additionally, some HMOs use incentive-driven formularies, which may influence drug selection by assigning different co-payment amounts to different drugs. Id. So, a formulary’s composition can have a significant effect on pharmaceutical sales— and drug company profits. “Because a drug’s inclusion on an [HMO’s] formulary can dictate prescription choices for patients covered by [HMOs], drug manufacturers seek to secure inclusion on [HMO] formularies as well as favorable placement within those formularies through financial rewards, including rebates, to [HMOs].” Id.

Foster claims that both Parke-Davis and BMS used such financial rewards to fight for position on OHP’s “very restrictive” formulary. (Relator’s Compl. at 9). Specifically, he explains that Parke-Davis’s Lipitor competed against BMS’s cholesterol-lowering drug, Pravachol — and *809 Pravachol prevailed. Pravachol was included in the OHP formulary; Lipitor was not. As such, Foster’s goal was for Lipitor to take Pravachol’s place. According to Foster, both Parke-Davis and BMS provided financial benefits to OHP representatives to influence their formulary decisions, resulting in a “bidding war” between the two companies. Id. at 10. OHP encouraged and escalated this bidding war by notifying each company of the various rebates, grants, donations and incentives the other was offering.

Foster claims that in negotiations that occurred between February 1998 and January 1999, various OHP representatives told him about incentives provided by BMS, including retroactive rebates; cash grants to OHP’s pharmacy department; and research grants, consulting and speaking fees, and other compensation given to the head of OHP’s Pharmacy and Therapeutics Committee, Dr. Richard Milani. (Relator’s Compl. at 11-15). Apparently, these incentives were better than those offered by Parke-Davis — and Pravachol maintained its place on the OHP formu-lary. Foster was told that Parke-Davis would have to beat BMS’s incentives before Lipitor would be added the formulary. However, Parke-Davis was unable to do so; BMS’s incentives were too great.

According to Foster, he learned the secret to BMS’s success in December 1998 from Vanessa Pappion, a BMS regional account representative. Pappion told Foster that BMS was able to offer such large discounts and bonuses to OHP (while still turning a profit) because BMS did not include the incentives in the “best price” amount it reported to Medicaid for Prava-chol and another drug called Glueophage. 3 By falsely inflating its “best price,” BMS reduced its obligation to pay Medicaid rebates. According to Foster, this scheme mitigated the cost of the OHP incentives. Foster claims that OHP’s pharmacy director, Tim Hambacher also described this practice to him in March 1999, stating that “the cash incentives provided by BMS effectively lowered the dose price of its products but was given in such a way as to not affect reports of ‘best price.’ ” (Relator’s Compl. at 15).

Plainly, appreciating these allegations requires some understanding of the Medicaid reimbursement program.

B. Medicaid Reimbursement

The Medicaid reimbursement program ensures that Medicaid has access to the same price discounts and deals received by commercial customers. In re: Pharmaceutical Industry Average Wholesale Price Litigation, 538 F.Supp.2d 367 (D.Mass.2008). The program requires a drug manufacturer, on a quarterly basis, to pay rebates to state Medicaid offices that have subsidized the purchase of that manufacturer’s drugs during that quarter. Id.; see 42 U.S.C. § 1396r-8. The rebate due is calculated by multiplying the difference between the “Average Manufacturer Price” (“AMP”) and the “Best Price” for the covered drug by the total number of units paid for by the state during that rebate period. Id. The AMP is defined as “the average price paid to the manufacturer for the drug in the United States by wholesalers for drugs distributed to the retail pharmacy class of trade.” 42 U.S.C. § 1396r-8(k)(i )(A). The “Best Price” is defined as “the lowest price available from the manufacturer during the rebate period” and must include “cash discounts, free goods that are contingent on any purchase requirement, volume discounts, and [non- *810 exempted] rebates.” 42 U.S.C. § 1396r-8(c)(l)(C)(I)-(ii). The Best Price ensures that the government is provided the lowest price on drugs.

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587 F. Supp. 2d 805, 71 Fed. R. Serv. 3d 952, 2008 U.S. Dist. LEXIS 73090, 2008 WL 4360697, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-ex-rel-foster-v-bristol-myers-squibb-co-txed-2008.