Insurer Suits Take Aim at ‘Pay for Delay,’ Copay Assistance

In recently filed lawsuits, major health insurers accuse pharmaceutical companies of engaging in behavior that illegally boosted sales of their products. However, the alleged schemes are very different both in terms of how they work and whether policymakers are likely to step in and definitively end the practices, experts tell AIS Health.

Two of the lawsuits concern “pay-for-delay” deals, in which drug manufacturers sidestep competition for their branded products by offering patent settlements that effectively pay generic manufacturers not to bring their products to market. Humana Inc. and Centene Corp., in separate lawsuits filed in New Jersey’s District Court on Sept. 22, accuse Merck & Co., Inc. of using such a tactic when conspiring with generic manufacturers to delay the market entry of generic substitutes for two blockbuster cholesterol drugs, Vytorin and Zetia.

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Leslie Small

Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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