The conspiracy allegedly resulted in the San Francisco Health Plan being forced to make thousands or even millions of dollars in excess payments to cover the cost of such medications.
The SF Health Plan is not the same as Healthy San Francisco, the city's historic 2006 bid to grant universal health care to the 82,000 adults here who live without insurance. The SF Health Plan extends mental, medical, and dental health coverage to about 50,000 people, including approximately 28,000 children in the city, and offers in-home support workers to the disabled and elderly. The plan is funded through a combination of federal and state dollars known in California as Medi-Cal and elsewhere as Medicaid.
The programs help low-income residents get health care, but its public subsidies are being endangered by a massive state budget deficit. So making sure the SF Health Plan is paying the appropriate price for prescription drugs, a $200 billion industry in the United States, is more important than ever.
McKesson and First DataBank, the lawsuit alleges, placed new stickers on drug packages so that everyone from private insurers to Medi-Cal to consumers without insurance who simply walk up to a pharmacy window and cover their drug treatments with cash paid far more than they should have, based on an industry calculation that's similar to the suggested retail price printed on our analogy of a bag of chips. Herrera says he took on the suit because San Francisco is not alone in overpaying for pharmaceuticals and he saw a chance to force greater reforms in the system.
"We make our decisions based on the facts and the law, and we do our best to protect consumers, taxpayers, and businesses alike," Herrera told the Guardian. "This impacts a lot of things. It's about protecting consumers from having high drug costs passed on to them. It's about protecting taxpayer dollars since this is the San Francisco Health Plan, and it's something that emanates out of a city program. But it's also about protecting businesses, because a lot of businesses and health plans are the ones footing the bill for increased drug costs."
First DataBank is not listed as a defendant in Herrera's suit but is described as "an unnamed co-conspirator." The company is a little-known subsidiary of the private, New Yorkbased media conglomerate Hearst Corp., which owns dozens of major publications including the San Francisco Chronicle, the Seattle Post-Intelligencer, Esquire, and The Oprah Magazine. Spokespersons for McKesson and First DataBank refused to comment for this story.
As far as revenue is concerned, First DataBank is a bit player in the world of pharmaceuticals. Court records in a related 2006 suit describe its annual pretax income as just $19 million, barely enough to cover the McKesson CEO's compensation last year.
But the company is nonetheless important to people who rely on prescription drugs. It's one of the few major companies in the United States that maintains a sophisticated electronic database of information on tens of thousands of prescription drugs. Plus, First DataBank possesses a virtual monopoly on the market because the company merged with its only real competitor, Medi-Span, in 1998.