CRA addresses U.S. government healthcare programs and pharmaceutical pricing in False Claims Act suit

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In this whistleblower suit, a relator alleged Bristol-Myers Squibb Co. (“BMS”) violated the False Claims Act and various state claims. The suit alleged that BMS underpaid Medicaid rebates as a result of its reporting of its Average Manufacturer Price.

CRA was asked to discuss U.S. government healthcare programs and their associated price frameworks and regulations. CRA’s work examined U.S. government healthcare programs and their reimbursement methodologies for prescription drugs, price reporting requirements and their evolutions over time, and traced how a reduction in reported prices impacts net expenditures for prescription drugs. CRA’s work examined impacts on the Medicaid Drug Rebate Program, but also the impacts of price reporting Average Sales Price on Medicare Part B and fees paid to PBMs for Medicare Part D.

The case ultimately settled.

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