It's Friday afternoon, so of course that's the perfect time for the 11th Circuit to drop a major pharmaceutical drug ruling.
Read it and -- depending on your perspective -- weep or woot.
The Judge does adopt a fairly novel policy argument rooted in how insurers supposedly price their premiums, effectively killing any kind of recovery for the insurers.
Not sure where he is coming up with some of this fact-finding in the context of a motion to dismiss:
The insurers have pled no facts in the complaint that suggest the insurers established premiums in a way inconsistent with the insurance industry’s conventional ratemaking procedures. We therefore must infer that the insurers do charge premiums established in that conventional manner. As a consequence, because the insurers consciously chose to assume the risk of paying for all medically unnecessary or inappropriate prescriptions of formulary-listed drugs—like Seroquel—we must further infer that they adjusted their premiums upward to reflect the projected value of claims for these prescriptions. Such estimates, when calculated properly, take into account all known risks that might cause the insurers to pay for medically unnecessary or inappropriate prescriptions.Ah yes, all businesses and their chief executives always act rationally and utilize the very best business practices, I think that's the big takeaway from the last few years.
Me, I'm hitting the surf -- have a great weekend!