The insurer is claiming that Biogen operated a two-part scheme to increase profits from the multiple sclerosis drugs, Tysabri, Avonex and Tecfidera, which cost between $50,000 and $80,000, according to the lawsuit.
Humana claims that Biogen “seeded” the market by providing free drugs to uninsured patients, which illegally interfered with medical and cost-based “insurance incentives.”
The drugmaker then allegedly swept patients into Medicare or other government-funded healthcare programs before working with partners to subsidize patients with copays, disguised as charitable giving. This meant that only those using Biogen’s multiple sclerosis drugs benefited from grants, creating incentives for patients and driving profits, the lawsuit claims.
Payers like Humana that offer Medicare Part D and Medicare Advantage plans, as well as taxpayers, take the financial hit from the scheme, the lawsuit claims.
A Biogen spokesperson told Becker’s that the company does not comment on active litigation.
