Prescription Drug Settlement Recovery Services
Recently there has been a dramatic increase in the number of class action settlements for which corporations or third-party payers are eligible to receive funds. These settlements approach very rapidly and changes are made throughout the filing processes that prohibit entities from collecting funds in a timely manner, if at all. The most common of these settlements involve pharmaceutical manufacturers as the defendants. Aside from the monetary aspect, there are several items of vital importance to plan sponsors:
- There is often a fiduciary aspect to these settlements as funds used to pay for the purchases are from plan assets
- It is quite often the case that insurance carriers or pharmaceutical benefit managers file on behalf of corporations and charge as much as 35% for recoveries without disclosing fees to plan sponsors
- Very rarely are reconciliations of any kind provided to the plan sponsors, so any recoveries received cannot be accounted for in full
- Claim level detail is often a prerequisite for successful filing, but plan sponsors are continually denied access to claims for the relevant settlement periods
- Filing a claim is only the first step, in many instances claims are defected or incomplete and a lack of knowledge on behalf of plan sponsors on how to correct the process in the allotted time period leads to nonpayment.
Managed Care Advisory Group (MCAG) has actively represented clients in Federal Court to assure that any preferential treatment given to class members is reflected in our client’s recoveries. Our clients can be assured that their best interests are continually represented.
We have successfully submitted hundreds of millions of dollars on behalf of plan sponsors into these settlements and our clients have recovered their pro rata share of the settlement funds as a result. MCAG has established a solid working relationship with many of the leading plaintiffs in the country to ensure our clients are fairly represented before, during and in the aftermath of each settlement.
MCAG has successfully filed on behalf of clients and received recoveries for dozens of settlements including some of the following:
- McKesson AWP
- Bextra and Celebrex Marketing, Sales Practices and Products Liability Litigation
- TriCor Indirect Purchaser Settlement
- Estratest Hormone Replacement Therapy (HRT) Settlement
- Vytorin/Zetia Marketing, Sales Practices and Products Liability Litigation
- Simonet Paxil CR Settlement
Prescription Drug Settlement Recovery Services FAQ’s
MCAG will need an executed agreement and BAA with your company in order to file on behalf of the benefit plan. MCAG will need to know which Health Insurer(s) or Pharmacy Benefit Manager (PBM) your organization used over the corresponding eligible time periods. MCAG will work with your plan administrators to gather all necessary claims data and file the claim.
It is not uncommon for health insurers or PBMs to file on behalf of plans into these settlements. However, most organizations do not use the same PBM or health insurer for more than a few years. The majority of settlements cover a period of up to a decade or more. If a PBM or health insurer files on behalf of your plan, they will likely only file for clients that are currently contracted and receiving their services. Even in those instances, cash payments are rare. A plan may receive a credit towards future invoices and the administrators may charge as much as 35% of recoveries. For clients that are no longer using the administrator’s services, a payment is almost never received.
MCAG only works on a contingency fee basis which means we do not receive payment unless our clients actually receive funds from the settlement. Due to our relationships with many associations, hospital systems and large brokerage firms, we are able to offer an extremely competitive rate for recoveries.
MCAG will work with you and your team to establish a minimum of twelve years of payer (TPA or PBM) history. MCAG will then establish a plan for gathering and aggregating all necessary data to maximize the claim payment. We will provide e-mail and letter templates for communication with payers as well as participating in phone calls or presentations. MCAG will provide detailed reconciliations to all clients upon request and we only provide cash payments. MCAG will file for any and all settlements for which your plan is eligible, ensuring that a payment opportunity is never missed.
Hospital System in WI
Early Retiree Reinsurance Program
Service for a Contingent Fee
We believe in aligning our incentives with your business goals. MCAG's Recovery Services utilize a contingency fee based pricing model so we do not receive payment unless we recover revenue for our clients.