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AFSCME v ADVANCEPCS et al Click to find out why . . .



Keywords & Phrases
CaseNo: AVAEA118085, CourtName: MISC 4, Plaintiff: AFSCME, State: CA California, UniqueCaseRef: LCD>AVAEA118085, Health, Pbms, Drug, Advancepcs, Rebates, Caremark, Health Plans, Scripts, Discounts, Spreads, Drug Manufacturers, Medco Health, Mail Order, Awp, Retail Pharmacies, Prescription Drug, Health Care, Plan Participants, Pharmaceuticals, Reimbursement Rate, Published Awp, Soft Dollars, California, Inflated Awps, Dispensing Fee, Negotiates, Therapeutically Equivalent, Beneficiaries , ContentID: 120254699

Case Documents
1   COMPLAINT
[ see first page and extracted highlights below  ] ItemID: 131791
55 pages
PDF
Total Documents: 1 document , 55 pages
Price: $ 19.95


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1 . COMPLAINT

EXTRACTED KEY WORDS
PBMS
DRUG
DEFENDANTS
ADVANCEPCS
REBATES
CAREMARK
HEALTH PLANS
SCRIPTS
DISCOUNTS
SPREADS
DRUG MANUFACTURERS
MEMBERS
MEDCO HEALTH
MAIL ORDER
AWP
RETAIL PHARMACIES
PRESCRIPTION DRUG
HEALTH CARE
PLAN PARTICIPANTS
PHARMACEUTICALS
REIMBURSEMENT RATE
PUBLISHED AWP
SOFT DOLLARS
CALIFORNIA
INFLATED AWPS
DISPENSING FEE
NEGOTIATES
THERAPEUTICALLY EQUIVALENT
BENEFICIARIES


 1     Kevin P. Roddy (State Bar No. 128283)
       Amanda L. Horn (State Bar No. 213891)
 2     HAGENS BERMAN LLP
       700 South Flower Street, Suite 2940
 3     Los Angeles, CA  90017-4101
       Telephone:  (213) 330-7150
 4      -and-
       Steve W. Berman
 5     Sean R. Matt
       HAGENS BERMAN LLP
 6     1301 Fifth Avenue, Suite 2900
       Seattle, WA  98101
 7     Telephone: (206) 623-7292

 8     Attorneys for Plaintiff

 9     [Additional Counsel Listed on Signature Page]

10
                                SUPERIOR COURT OF THE STATE OF CALIFORNIA
11
                                     FOR THE COUNTY OF LOS ANGELES
12
       AMERICAN FEDERATION OF STATE,                          )    No.
13     COUNTY & MUNICIPAL EMPLOYEES,                          )
                                                              )    REPRESENTATIVE ACTION AND
14      Plaintiff,
                                                              )    COMPLAINT FOR VIOLATIONS OF
                                                              )    THE UNFAIR COMPETITION LAW
15      v.                                                    )
                                                              )    Jury Trial Demanded
16     ADVANCEPCS; CAREMARK, RX;                              )
       CAREMARK, INC.; EXPRESS SCRIPTS,                       )
17     INC.; MEDCO HEALTH SOLUTIONS, INC. as )
       successor-in-interest to MERCK-MEDCO                   )
18     MANAGED CARE, L.L.C.,                                  )
                                                              )
19      Defendants.
                                                              )

20

21

22

SNIPPETS:
  • MEDCO HEALTH SOLUTIONS,
  • Rebates and "soft dollars"
  • Pocketing undisclosed mail order discounts
  • G. AdvancePCS
  • 10 have been or are administered by one or more of the Defendants, and all California public
  • 15 used PBM's in an effort to reduce their health care costs.
  • 11 to hide rebates and other financial inducements provided to them by prescription drug
  • on behalf of non-ERISA health plans having prescription drug benefit provisions that were or
  • administered by one or more of the Defendants, and on behalf of individual members of non5
  • 24 pharmaceutical manufacturers and discounts from retail pharmacies in order to generate
  • 27 seeks to replace each plan sponsor as the party who negotiates lower
  • 16 Caremark Rx is one of the largest pharmaceutical services companies in the United States,
  • Express Scripts
  • PBMs comprise the significant market share of the PBM market.
  • 18 rebates with drug manufacturers.
  • 25 pharmaceuticals used by a health plan's members.
  • 19 and the spreads that the drug manufacturers provide the PBMs.
  • falling into three general categories: garnering rebates and other "soft dollars" from drug
  • Medicare program and harming beneficiaries who are required to pay
  • PBMs use the inflated AWPs set by drug manufacturers as
  • to each drug's AWP, less a specified discount, plus a dispensing fee.
  • the PBM Defendants contract with health plans to use the published AWP as
  • 20 determining the reimbursement rate for drugs on the formulary,
  • 21 for the provision of drugs to plan participants and determining the reimbursement rate to
  • switch plan participants and beneficiaries from higher-cost therapeutically equivalent drugs
  •    |