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 this Claim Form and mail it to the Notice and Claims Administrator at the address provided below postmarked, or submit your claim online, no later than February 3, 2023.

To file your claim by mail, download a copy of the Claim Form below

• Consumer Claim Form

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 health insurance companies, self-insured health and welfare plans that make payments from their own funds, and other health benefit providers and entities with self-funded plans that contract with a health insurer or administrator to administer their prescription drug benefits. Third-Party Payors include such private entities that may provide prescription drug benefits for current or former public employees and/or public benefits programs, but only to the extent that such a private entity purchased for consumption by its 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.

• Third-Party Payor Filing Template
• Applicable NDC List updated 1/10/2023

To file your claim by mail, download a copy of the Claim Form below

• Third-Party Payor Claim Form