The Settlement Class includes all health insurance companies, health maintenance organizations, self-funded health and welfare benefit plans, other Third-Party Payors, and any other health benefit provider in the United States of America or its territories that paid or incurred costs for Valeant’s branded drug products in connection with a claim submitted by Philidor, a claim submitted by any pharmacy in which Philidor had a direct or indirect ownership interest, or a claim by any pharmacy for which the amount sought for reimbursement was alleged to be inflated as a result of Defendants’ allegedly fraudulent scheme, from January 2, 2013 through November 9, 2015, and allegedly suffered damages thereby.
A Third-Party Payor (or “TPP”) is an entity in the United States of America or its territories that was (i) a party to a contract, issuer of a policy, or sponsor of a plan and (ii) at risk, under such contract, policy, or plan, to pay or reimburse all or part of the cost of prescription drugs dispensed to covered natural persons.
TPPs include insurance companies, union health and welfare benefit plans, and self-insured employers. Entities with self-funded plans that contract with a health insurance company or other entity to serve as a third-party claims administrator to administer their prescription drug benefits qualify as TPPs. Private plans that cover government employees and/or retirees are also included.
Excluded from the Settlement Class are Pharmacy Benefit Managers, Defendants, Defendants’ successors and assigns, and any entity in which any Defendant has or had a controlling interest. Also excluded from the Settlement Class are any entities that submit a Request for Exclusion from the Settlement Class that is accepted by the Court.
Excluded from the Settlement:Defendants and their officers, directors, management, employees, subsidiaries, and affiliatesGovernment entities, other than government-funded employee benefit plans Fully insured health plans (i.e., plans that purchased insurance that covered 100% of the plan’s reimbursement obligations to its members)“Single flat co-pay” consumers who purchased EpiPens or generic EpiPens only via a fixed dollar co-payment that is the same for all covered devices, whether branded or generic (e.g., $20 for all branded and generic devices)Consumers who purchased or received EpiPens or authorized generic equivalents only through a Medicaid program All persons or entities who purchased branded or generic EpiPens directly from defendantsThe judges in this case and members of their immediate families All third-party payors who own or otherwise function as a Pharmacy Benefit Manager or control an entity who functions as a Pharmacy Benefit Manager Individual consumers whose only purchases of an EpiPen occurred before March 13, 2014 (the Generic Start Date)
