Advance PCS v. Bauer, 280 Ga. 639

Summary

The Supreme Court of Georgia held that breast cancer survivors’ Georgia unjust-enrichment claims against a pharmaceutical benefits manager, based on the alleged misclassification of tamoxifen as a brand-name drug, were preempted by ERISA. The claims were expressly preempted under ERISA § 514(a) because liability depended on the terms of the plaintiffs’ ERISA plans, and impliedly preempted under § 502(a) because the plaintiffs could have pursued the matter through ERISA’s civil enforcement provisions. The court reversed the Court of Appeals.

Holdings

1. The plaintiffs' Georgia unjust-enrichment claims were expressly preempted because they related to ERISA plans and depended entirely on the plans' language and terms governing the classification of tamoxifen and the applicable co-payment.
2. The plaintiffs' claims were impliedly or completely preempted under ERISA § 502(a) because they could have been brought to recover benefits or enforce rights under the plans, and Advance PCS's alleged duty did not arise independently of the plans.

Questions Presented

1. Whether the plaintiffs' Georgia unjust-enrichment claims were expressly preempted under ERISA § 514(a) because their entitlement to a generic or brand-name co-payment depended on the terms of their ERISA plans.
2. Whether the plaintiffs' claims were impliedly or completely preempted under ERISA § 502(a) because they could have been brought as claims to recover benefits or enforce rights under the plans and involved no independent legal duty.

Disposition

reversed