Johnson & Johnson (J&J) Lawsuit against SaveOnSP Cleared to Continue

Johnson & Johnson has been cleared to continue a lawsuit filed last year against drug benefit program SaveOnSP, which claims it defrauded a payment assistance program for patients out of “at least $100 million.”

SaveOnSP administers employer plan benefit designs that deliver cost-savings. SaveOnSP’s single focus is on helping employer plan sponsors and their participants manage the skyrocketing costs of specialty medications.

The complaint – originally filed in May 2022 in a New Jersey federal court – alleges that SaveOnSP took advantage of J&J’s Janssen CarePath program, which covers eligible patients’ out-of-pocket expenses for 44 of its more expensive prescription drugs, including complex biologic treatments for various cancers, pulmonary arterial hypertension, and autoimmune disorders.

SaveOnSP had attempted to have the legal action dismissed, but that was denied, allowing J&J to continue to press its case. It is being supported by several patient advocacy groups, including the AIDS Institute, the National Oncology State Network, and the HIV + Hepatitis Policy Institute.

The complaint says that the SaveOnSP program involves reclassification of medicines from essential to non-essential in order to avoid copay limits and annual out-of-pocket limits mandated by the US Affordable Care Act (ACA), which puts a ceiling on the amount a patient with private insurance can be required to pay for medical care each year.

After the drug is re-designated, the SaveOnSP program “increases the patient’s copay amount for the given drug to an artificially high amount – often thousands of dollars per dose,” it continues.

SaveOnSP is accused of using those high copays to coerce patients into enrolling into its program, without telling them that they can access other schemes like J&J’s CarePath. Once enrolled into SaveOnSP, the inflated copay amounts are billed to CarePath, draining its available funds.

Evernorth Express Script’s first-to-market innovative copay solutions helps customers afford their medications, protect plan design preferences and achieve lower trend. In partnership with SaveOnSP on the first non-essential health benefits copay assistance solution, the company has driven significant savings by targeting high cost, high-volume drugs.

SaveOnSP recommends plan design and coverage changes for certain drugs, enabling maximum savings and reducing plan and client costs. As manufacturer programs and regulations change, this aggressive solution adapts, delivering lower specialty plan cost and enhanced customer support.

Takeaway: According to court documents, SaveonSP works in partnership with Express Scripts and Accredo Health to operate the program