Attorney General Bob Ferguson announced a federal lawsuit in collaboration with six other attorneys general, accusing Regeneron Pharmaceuticals of inflating Medicaid prices for an essential eye medication. The lawsuit alleges that the New York-based company engaged in practices that led to millions of dollars in losses for state Medicaid programs.
"We're fighting corporate greed in order to protect public health care dollars and improve the affordability of medications," Ferguson stated. "This is how we protect Medicaid dollars that allow us to provide access to health care for nearly two million Washingtonians, including children and the most vulnerable."
Regeneron manufactures Eylea, an FDA-approved drug used to treat macular degeneration and other eye conditions. Medicaid, a joint federal-state program, provides health care benefits including prescription drug coverage for medications like Eylea to qualified individuals such as low-income families, the elderly, and people with disabilities. Between 2013 and 2023, Medicaid programs in Colorado, Georgia, Michigan, North Carolina, Texas, and Washington collectively spent over $175 million on Eylea.
The complaint filed in the U.S. District Court for the District of Massachusetts claims that Regeneron was required to include all price concessions for Eylea in its Average Sales Price (ASP) reporting to the Centers for Medicare and Medicaid Services (CMS). However, it allegedly failed to report credit card processing fees paid to distributors that allowed them to offer lower effective prices for Eylea. This omission purportedly enabled doctors and retina practices purchasing Eylea to receive substantial "cash back" rewards and other credit card benefits.
By not reporting these fees as price concessions, Regeneron is accused of falsely inflating each state's Medicaid reimbursement rates for Eylea. The lawsuit originated from a whistleblower case already pursued by the U.S. Department of Justice under the federal False Claims Act. The states involved seek monetary damages and penalties under their respective false claims acts or other state laws.
Washington's Attorney General’s Medicaid Fraud Control Division is leading the investigation into this alleged fraud against the state's Medicaid program. The division receives 75% of its funding from the U.S. Department of Health and Human Services through a grant totaling $9,062,900 for FY 2024; the remaining 25%, amounting to $3,021,000 for FY 2024, comes from Washington state Medicaid fraud recoveries.
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The Attorney General’s Office serves as Washington's largest law firm providing legal representation across state agencies while also enforcing consumer protection laws among others. It prosecutes elder abuse cases and handles sexually violent predator cases across most counties in Washington.
Visit www.atg.wa.gov for more information.
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