Under the Medicaid Drug Rebate Program, drug
manufacturers of brand name drugs (i.e. non-generic drugs) are required
to report to the government the prices they charge their customers,
including the "best price" offered for their drugs. They also are
required to pay rebates to the state Medicaid programs that are
calculated on any discounted prices that are offered. Congress created
the Medicaid Drug Rebate Program in order to ensure that Medicaid, one
of the largest purchasers of drugs in
Between 2000 and 2006, Wyeth offered steep discounts to thousands of hospitals nationwide for Protonix Oral and Protonix IV under a pricing arrangement known as the "Protonix Performance Agreement." This pricing arrangement required that the hospitals purchase both drugs together under a so-called "bundled" arrangement and it offered them a steep discount for doing so. Wyeth did this in part to gain access to the far more lucrative retail outpatient market, intending that patients who used the intravenous version of Protonix in the hospital would later purchase Protonix Oral once they were discharged from the hospital. Under the Protonix Performance Agreement, hospitals that placed both products on their formularies and attained certain market share requirements were entitled to up to a 94% discount off the list price of Protonix Oral and up to 80% off the list price of Protonix IV. Although Wyeth was required under the Medicaid Drug Rebate Program to determine the effective prices paid by hospitals under this arrangement, and to pass along the benefit of the lowest prices to the state Medicaid programs, Wyeth allegedly failed to do so and therefore avoided paying hundreds of millions of dollars to Medicaid in quarterly rebates.
"Our complaint charges that Wyeth created the
Protonix bundle so they could increase their market share at the
expense of the Medicaid program -- a program to provide the least
advantaged Americans with necessary medical care and services," said
The two separate civil False Claims Act suits - called qui tam actions - were filed against Wyeth and are pending in the District of
"The
best price reporting requirement is designed to assure that the
nation's healthcare programs for the poor - the Medicaid programs - are
treated equally with drug companies' best commercial customers," said
The
investigation was conducted by the Civil Division of the U.S.
Department of Justice, the U.S. Attorney's Office for the District of
SOURCE U.S. Department of Justice