Mosaic Health, Inc. v. Sanofi-Aventis U.S., LLC

No. 24-598 (2d Cir. Oct. 15, 2025) (amended) · United States Court of Appeals for the Second Circuit · October 15, 2025 · No. 24-598

Summary

The Second Circuit held that federally funded health centers plausibly alleged that several drug manufacturers engaged in a horizontal price-fixing conspiracy concerning Section 340B discounts for drugs dispensed through contract pharmacies. The court concluded that Astra and Illinois Brick did not bar the plaintiffs’ Sherman Act claims or their limited lost-profit and injunctive-relief requests. It vacated the district court’s dismissal and denial of leave to amend and remanded for the plaintiffs to file their proposed second amended complaint.

Court
United States Court of Appeals for the Second Circuit
Writing for the Court
Myrna Pérez; Richard C. Wesley Nathan; Kahn
Jurisdiction
United States Court of Appeals for the Second Circuit
Decision date
October 15, 2025
Docket number
24-598
Procedural posture
Plaintiffs appealed the dismissal of their first amended putative class-action complaint and the denial of leave to file a proposed second amended complaint as futile.
Standard of review
The court reviewed dismissal under Federal Rule of Civil Procedure 12(b)(6) de novo and reviewed denial of leave to amend de novo because the denial was based on futility and an interpretation of law. At the pleading stage, factual allegations are accepted as true and reasonable inferences are drawn in the plaintiff's favor.
Precedential value
published
Parties
Mosaic Health, Inc., Central Virginia Health Services, Inc., individually and on behalf of all those similarly situated v. Sanofi-Aventis U.S., LLC, Eli Lilly and Company, Lilly USA, LLC, Novo Nordisk Inc., AstraZeneca Pharmaceuticals LP
Disposition
vacated

Topics

commercial litigationhealth lawfederal spendingappellate procedurestandard of review

Practice areas

antitrustcommercial litigationhealth lawappellate procedure

Questions Presented

  1. Whether the proposed second amended complaint plausibly pleaded a horizontal price-fixing conspiracy under Section 1 of the Sherman Act.
  2. Whether Astra USA, Inc. v. Santa Clara County barred Plaintiffs' Sherman Act claims because the claims concerned the Section 340B Drug Discount Program.
  3. Whether Illinois Brick Co. v. Illinois barred Plaintiffs' federal antitrust claims for damages and injunctive relief.
  4. Whether the district court erred in denying leave to amend as futile.
  5. Whether the district court was required to reconsider the proposed state-law antitrust and unjust-enrichment claims in light of the adequately pleaded federal conspiracy claim.

Holdings

  1. Astra did not bar Plaintiffs from bringing Sherman Act claims because Plaintiffs sought relief for an alleged antitrust conspiracy, not enforcement of Section 340B ceiling-price obligations or Pharmaceutical Pricing Agreements.
  2. Illinois Brick did not bar Plaintiffs from seeking damages for lost access and lost profits rather than overcharge damages.
  3. Illinois Brick did not bar Plaintiffs' request for injunctive relief under Section 16 of the Clayton Act.
  4. Antitrust plaintiffs need not plead exactly identical conduct occurring within a tightly synchronized period; conduct may be parallel when it is generally similar in substance, timing, or anticompetitive effect and supports an inference of concerted action.
  5. The proposed second amended complaint adequately alleged plus factors supporting a plausible inference of conspiracy, including a common motive, conduct contrary to each defendant's individual economic self-interest, and a high level of interfirm communications.
  6. The district court erred in denying leave to amend as futile because the proposed second amended complaint plausibly stated a Section 1 claim.

Key quotations

Rather, plaintiffs must state facts consistent with defendants’ having engaged in conduct that contributes to an inference of concerted action. (24)
This Court concludes that the proposed second amended complaint pleads sufficient facts to support a plausible inference of a horizontal price-fixing conspiracy through circumstantial allegations, where both (1) the conduct that Plaintiffs allege was sufficiently parallel, as the Defendants’ announced policies were similar enough in substance, timing, and effect; and (2) Plaintiffs alleged sufficient circumstantial plus factors, including a common motive to conspire, parallel conduct contrary to the Defendants’ individual economic self-interest, and a high level of interfirm communications. (34)

Factual background

Plaintiffs are federally funded safety-net health centers serving low-income patients and participating in the Section 340B Drug Discount Program. Defendants are competing manufacturers of diabetes drugs who allegedly jointly lobbied against the program and then, beginning in 2020, adopted policies restricting or eliminating 340B discounts for drugs dispensed through contract pharmacies. Plaintiffs alleged that the manufacturers' actions were similar in substance, timing, and effect, increased profits, reduced competition, and were supported by common lobbying activity and interfirm communications.

Procedural history

Plaintiffs alleged that drug manufacturers conspired to restrict Section 340B discounts for drugs dispensed through contract pharmacies, in violation of federal and state antitrust law and state common law. The United States District Court for the Western District of New York dismissed the first amended complaint and denied leave to file the proposed second amended complaint, concluding that Plaintiffs had not adequately pleaded parallel conduct or facts supporting an inference of conspiracy. The Second Circuit vacated and remanded, directing the district court to grant leave to file the second amended complaint and to reconsider the state-law claims.

Remand instructions

The district court must grant Plaintiffs leave to file their proposed second amended complaint and reexamine the state-law antitrust and unjust-enrichment claims consistently with the Second Circuit's conclusion that Plaintiffs plausibly alleged a horizontal price-fixing conspiracy.

Court Document

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