Pfizer escapes proposed class action lawsuit over patient copay assistance

Two months after taking a loss in a U.S. Supreme Court appeal, which prevents Pfizer from implementing a cost-sharing assistance program for its heart disease drugs Vyndaqel and Vyndamax, the company has gotten a win in a parallel case in a different court in Washington, D.C.

In U.S. District Court, Pfizer has prevailed over five collection companies which sought to bring a potential class action lawsuit alleging that Pfizer illegally induced patients to a select group of drugs.  

The five plaintiffs—including MSP Recovery Claims and Series LLC—are companies that seek to recover overpayments on behalf of private insurers that administer Medicare and Medicaid programs. The plaintiffs alleged that they were damaged by a “conspiratorial scheme to increase the unit price” of several drugs from 2012 to 2016.

Pfizer did it, the companies alleged, by donating to the Patient Access Network Foundation and Advanced Care Scripts to help cover the cost of patients’ co-pays. This in turn induced patients to use Pfizer drugs when less expensive alternatives were available, according to the complaint.

In court documents, the plaintiffs contended that insurers “were forced to pay for artificially increased amounts of the subject drugs” in an amount exceeding $20 billion.

The drugs in question included arrhythmia treatment Tikosyn and renal carcinoma treatments Sutent and Inlyta. In 2016, for example, the trio combined for $1.65 billion in sales.  

U.S. District Judge Dabney L. Friedrich ruled that the plaintiffs did not bring enough evidence to support their claim.

“The court cannot accept inferences that are unsupported by the facts set out in the complaint,” Friedrich wrote. 

In 2018, Pfizer agreed to pay $23.8 million settlement to the U.S. government resolve claims that it used a foundation as a conduit to fund the copays of Medicare patients taking Sutent, Inlyta and Tikosyn, in violation of the False Claims Act.  

The latest decision comes after Pfizer, in February, was denied a rehearing of its appeal to establish a similar cost-sharing program, which would have helped patients cover out-of-pocket costs for Vyndaqel and Vyndamax.

The ruling reaffirmed a 2019 decision that found that Pfizer’s planned arrangement would break a criminal ban on financial support to patients for a federally reimbursed healthcare product.

Pfizer argued that the case was chance for SCOTUS to address a “staggeringly overbroad” interpretation of anti-kickback laws.