In the United States, more than 200 million people have insurance coverage that includes a pharmacy benefit, and this benefit is usually managed by a Pharmacy Benefit Manager (PBM). Because of this large influence, pharmaceutical companies have a lot riding on whether they are included on PBMs’ formularies. This power dynamic is ripe for kickbacks.
For example, in February 2015, AstraZeneca paid the government $7.9 million to settle a qui tam action alleging that the manufacturer “paid hundreds of millions of dollars in inducements and kickbacks to [PBM giant] Medco . . . to obtain favorable formulary position, recommendation, and purchase of Nexium.”
In announcing this recovery for taxpayers, Acting Assistant Attorney General Joyce stated, “Hidden financial agreements between drug manufacturers and pharmacy benefit managers can improperly influence which drugs are available to patients and the price paid for drugs.”
More information for whistleblowers is located at the Nolan Auerbach & White website.