Our consumer protection attorneys are investigating allegations that certain insurance companies are not covering generic versions of medication, to force their customers to buy the brand-name version of the drug.
Drugs that may be affected include:
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NY Times: Pharmaceutical Companies Cutting Back-Room Deals to Force Consumers to Buy Brand-Name Over Generics
According to The New York Times,
Out of public view, corporations are cutting deals that give consumers little choice but to buy brand-name drugs — and sometimes pay more at the pharmacy counter than they would for generics.
The NY Times questioned the continued success of certain brand-name drugs, such as Adderall XR, “long after generic competitors arrived on the market.” Shire, the manufacturer of the drug, made $342 million in sales from Adderall XR in 2016. One pediatrician said that he noticed “very odd things” happening with Adderall XR starting in 2015. Pharmacies began telling him that he needed to prescribe the brand-name version of the drug for his patients to have the drug covered by insurance, according to the NY Times.
The NY Times reports that Shire and other pharmaceutical companies, no longer willing to cede market share when generic drugs become available, are making deals with insurers and pharmacy benefit managers (PBMs) to “give priority” to the brand-name drug. Shire effectuated its plan by giving “rebates” to the insurance companies and PBMs.
UnitedHealthcare, CVS Caremark Allegedly Limiting Coverage to Expensive Branded Drugs
Naomi Freundlich bought the generic version of Adderall XR for her son for two years. Her health plan, UnitedHealthcare, required her to pay out of pocket for the drug until she hit her deductible of $3,000. In 2014, her pharmacist told her that United would only cover the brand-name version of Adderall XR, which cost $50 more per month than the generic. One doctor called it “Alice-in-Wonderland” when insurers start requiring patients to buy the more expensive version of the drug.
Additionally, UnitedHealth recently told healthcare providers that it preferred “Remicade, the expensive rheumatoid arthritis drug made by Johnson & Johnson, over biosimilars that have a lower price,” the NY Times reports.
CVS Caremark, one of the nation’s largest PBMs, sent a memo to pharmacies, says the NY Times, informing them that for 12 drugs, some of Caremark’s prescription drug plans would only be covering the brand-name version.
An employee for Teva, which manufactures Copaxone, a brand-name multiple sclerosis drug, said that she had seen a “more aggressive posture” by manufacturers of brand-name drugs to maintain their sales numbers. According to the NY Times, Teva has been pushing its “three-times-weekly version of Copaxone” because this version has no generic competitors, unlike other dosages of Copaxone.
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