Claim Forms

Individual Consumers
If you are a member of the Class as a consumer, you may file a claim for a share of the Settlement Fund. You must complete a Claim Form and mail it to the Claims and Notice Administrator, or submit your claim online, no later than January 5, 2023.

To file your claim by mail, download a copy of the Claim Form below
Online filing is no longer available


Third-Party Payors (TPPs)
TPPs are entities (besides the patient) that provide payment or reimbursement for health care expenses, like prescription drug benefits. They include entities such as, self-insured health and welfare plans and health insurance companies that make payments from their own funds, and other health benefit providers and entities with self-funded plans that contract with a pharmacy benefit manager (PBM) or administrator to administer their prescription drug benefits for their members, employees, insureds, participants, or beneficiaries.

The Notice and Claims Administrator may request supporting documentation in addition to the documentation and information requested below. The Notice and Claims Administrator may reject a claim if the Class Member or their authorized agent does not provide all requested documentation in a timely manner.

To file your claim by mail, download a copy of the Claim Form below
Online filing is no longer available

Note: These documents are in PDF format. To view the
documents, you will need Adobe Acrobat Reader on your computer or other internet-enabled device.


Court Documents
Individual Consumers
If you are a member of the Class as a consumer, you may file a claim for a share of the Settlement Fund. You must complete a Claim Form and mail it to the Claims and Notice Administrator, or submit your claim online, no later than January 5, 2023.

To file your claim by mail, download a copy of the Claim Form below
Online filing is no longer available


Third-Party Payors (TPPs)
TPPs are entities (besides the patient) that provide payment or reimbursement for health care expenses, like prescription drug benefits. They include entities such as, self-insured health and welfare plans and health insurance companies that make payments from their own funds, and other health benefit providers and entities with self-funded plans that contract with a pharmacy benefit manager (PBM) or administrator to administer their prescription drug benefits for their members, employees, insureds, participants, or beneficiaries.

The Notice and Claims Administrator may request supporting documentation in addition to the documentation and information requested below. The Notice and Claims Administrator may reject a claim if the Class Member or their authorized agent does not provide all requested documentation in a timely manner.

To file your claim by mail, download a copy of the Claim Form below
Online filing is no longer available

Note: These documents are in PDF format. To view the
documents, you will need Adobe Acrobat Reader on your computer or other internet-enabled device.