UPDATE: The Court granted the motion for final approval on January 15, 2025. You can review the Final Approval Order by clicking here.
UPDATE (January 2, 2025): The claim form for this settlement has been updated. You can locate the updated claim form by clicking here. The online claim form has also been updated. If you have already filed a claim, you do not need to re-submit it using the new form.
Third-Party Payor (“TPP”) Class Member, or an authorized agent can complete this Claim Form. Individual consumers are not part of this lawsuit.
TPPs are entities (besides the patient) that provide payment or reimbursement for health care expenses, like prescription drug benefits. They include entities such as health insurance companies, self-insured health and welfare plans that make payments from their own funds, and other health benefit providers and entities with self-funded plans that contract with a health insurer or administrator to administer their prescription drug benefits. Third-Party Payors include such private entities that may provide prescription drug benefits for current or former public employees and/or public benefits programs, but only to the extent that such a private entity purchased for consumption by its members, employees, insureds, participants, or beneficiaries.
The Notice and Claims Administrator may request supporting documentation in addition to the documentation and information requested below. The Notice and Claims Administrator may reject a claim if the Class Member or their authorized agent does not provide all requested documentation in a timely manner.
If you are unable to break down the number of covered lives by state, please complete the chart on the Claim Form with the number of covered lives by year. If you do not have enrollment data for a particular year or years you may leave the entry for that year blank.
To file your claim by mail, download a copy of the claim form below
Note: These documents are in PDF format. To view the
documents, you will need Adobe Acrobat Reader on your computer or other internet-enabled device.
