Insurer sues Biogen over drug copay funding scheme

Sept. 27, 2021

Managed-care provider Humana has accused Biogen of illegally boosting sales of its expensive multiple sclerosis drugs by temporarily providing the drugs for free to patients and then funneling money to the patients for copays.

Humana sued Biogen and specialty pharmacy Advanced Care Scripts in Massachusetts District Court over an alleged copay funding scheme related to three high-priced multiple sclerosis drugs — Tysabri, Avonex, and Tecfidera. According to the lawsuit, after giving free samples of the drugs to patients who lacked medical insurance, Biogen then encouraged them to sign up for Medicare and other government insurance programs.

From there, the lawsuit contends, the defendants conspired to funnel illegal copayment assistance to patients so that Biogen could continue to receive payments from Medicare and its contract insurers, including Humana.

Biogen was accused of "sweeping" patients into government insurance programs through its charity giving, funneling money through two medical charities — the Chronic Disease Fund and The Assistance Fund — as well as Advanced Care Scripts; all three of which have already inked federal settlements.

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