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Cigna Gets Counts Dismissed in Prescription Drug Clawback Suit

Bloomberg Law

September 1, 2020


Cigna Health & Life Insurance Co. convinced a federal judge in Connecticut to trim a proposed class action claiming the insurer schemed with pharmacy benefit manager OptumRx Inc. to overcharge health plan participants for prescription drugs.

Judge Jeffrey Alker Meyer of the U.S. District Court for the District of Connecticut on Monday dismissed Billy Ray Blocker’s state law claims alleging breach of contract and breach of the implied covenant of good faith and fair dealing. Cigna isn’t a party to Blocker’s health plan, which is self-funded by a county government in suburban Atlanta, and there’s no indication Cigna assumed any obligations under the health plans between Blocker and the county, Meyer said.

Meyer’s ruling addressed only two of the lawsuit’s 10 counts.

The lawsuit accuses Cigna and other defendants of scheming to overcharge people for prescription drugs, sometimes by as much as 300%. The lawsuit claims that when a given prescription drug costs less than a patient’s copayment amount, the insurer “claws back” the difference through an improper scheme kept hidden from patients. This sometimes causes insured patients to pay more for drugs than they would without insurance, with pharmacists contractually prohibited from telling patients this information, according to the lawsuit. The lawsuit was allowed to proceed over Cigna’s motion to dismiss in 2018.

Other insurers have been accused of similar violations. UnitedHealth Group Inc. defeated a clawback lawsuit in 2017. Humana entered into a confidential settlement in 2018, and cases against CVS Health Corp. and Walgreens Boots Alliance were voluntarily dismissed.

The health plan participants are represented by Zimmerman Reed PLLP; Whitfield, Bryson & Mason LLP; Keller Rohrback LLP; Izard, Kindall & Raabe LLP; Scott & Scott LLP; Motley Rice LLC; Sarraf Gentile LLP; and Lockridge, Grindal, Nauen PLLP.

Cigna is represented by Morgan, Lewis & Bockius LLP.

The case is Negron v. Cigna Health & Life Ins. Co., 2020 BL 331303, D. Conn., No. 3:16-cv-01702, 8/31/20.


To contact the reporter on this story: Jacklyn Wille in Washington at jwille@bloomberglaw.com