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Harvard Pilgrim Sued for Terminating Coverage of Compounded Medications

Tuesday, July 23, 2013


Patrick Sheehan, WhatleyKallas, LLP, (617) 573-5118
David Pastor, Pastor Law Office, LLP, (617) 742-9700



Boston, MA. In a potentially devastating move for the health of its members, Harvard Pilgrim Health Care, one of the region's largest health insurers, has announced a decision to terminate coverage for all compounded medications in an effort to cut costs. The new policy is set to go into effect on August 7, 2013.  In response, attorneys with the national law firms WhatleyKallas, LLP and Pastor Law Office, LLP have filed a class action in the United States District Court for the District of Massachusetts to enjoin the move.

"Harvard Pilgrim's decision to terminate coverage for compounded medications is a direct threat to its members' health and safety," said Patrick Sheehan, a partner at WhatleyKallas, LLP.  "This lawsuit seeks to protect Harvard Pilgrim's members by enjoining the company from implementing its decision so that no member suffers an interruption in coverage for medically necessary medications."

"Harvard Pilgrim's announced policy poses a threat to its health plan members who use compounded drugs, because many patients will no longer be able to afford these drugs and may suffer adverse health consequences," said David Pastor, principal of Pastor Law Office, LLP.   "For this reason, a preliminary injunction is necessary to protect plan members from this policy taking effect."

The complaint filed in the lawsuit alleges that Harvard Pilgrim's decision represents a material change in its members' coverage, a significant reduction in benefits, and a violation of the standards of clinically appropriate care.  The suit further alleges that if the policy is permitted to go into effect, Harvard Pilgrim's members would be faced with the risk of irreparable harm to their health by losing coverage for medically necessary and often expensive compounded medications.  Based on these allegations, the suit claims that the change violates the Employee Retirement Income Security Act of 1974 ("ERISA").  A motion for preliminary injunction filed concurrently with the complaint seeks to enjoin Harvard Pilgrim from putting the change into effect until the Court rules upon the merits of the suit.

Last Friday, a separate but related action was filed in Norfolk County Superior Court on behalf of three local compounding pharmacies who stand to lose significant revenues if Harvard Pilgrim's new policy goes into effect.  That action, filed by Burns & Levinson LLP, alleges violations of Massachusetts state law and also seeks an injunction.

Download the class action complaint and accompanying motion for preliminary injunction filed against Harvard Pilgrim here.

The lawyers of WhatleyKallas, LLP have been repeatedly recognized in legal publications, such as The National Law Journal and American Lawyer, by their peers and by leaders of organized medicine for their work in the healthcare field. For more information, go to:

Pastor Law Office, LLP is a nationally recognized law firm with substantial experience and success in class action and consumer protection litigation, including lawsuits against major retailers, manufacturers, and real estate firms.   For more information, go to: