OPINION AND ORDER
Sidney Hillman Health Center of Rochester (“Hillman”) and Teamsters Health Services and Insurance Plan Local 404 (“Local 404,” and collectively with Hillman, the “Funds”) are multi-employer benefit plans and health services funds that provide health benefits, including prescription drug coverage, to their members. The Funds seek to represent a nationwide class of such third-party purchasers or third-party payors (“TPPs”) who from 1998 to 2012 reimbursed and paid all or some of the purchase price for Depakote, a drug developed and initially marketed by Abbott Laboratories and later by AbbVie, Inc. (collectively, “Abbott”), for indications not approved' by the Food and Drug Administration (the “FDA”).
BACKGROUND
Since 1983, the FDA has approved De-pakote (divalproex sodium), which is sold and marketed by Abbott, for the treatment of epileptic seizures, acute manic or mixed
Nonetheless, Abbott has marketed De-pakote for such unapproved “off-label” uses. To do so, it has used intermediary marketing firms, allegedly independent entities, paid physician spokespeople, as well as its own internal sales divisions. These efforts resulted in dramatically increased sales of Depakote, reaching $1.5 billion in 2007.
Abbott established and controlled three enterprises to promote off-label Depakote uses. First is what the Funds have termed the “CENE Enterprisé,” comprised of Abbott, associated physicians, the Council for Excellence in Neuroscience Education (“CENE”), and ACCESS Medical Group (“ACCESS”). CENE—a purportedly independent continuing education medical group with undisclosed ties to Abbott— disseminated materials and sponsored we-binars and meetings on off-label Depakote uses. CENE ■ also. retained “faculty” and “council” physician members to promote Depakote for off-label uses. ACCESS aided CENE by creating continuing education materials, including slide show presentations for use by doctors in Abbott’s speakers’ bureau. The second—the so-called “PharmaCare Enterprise”—included Abbott, its sales representatives, and PharmaCare Strategies,' Inc. (“Pharma-Care Strategies”), a market development firm that trained Abbott employees to successfully promote Depakote for off-label uses. PharmaCare Strategies conducted its training off-site rather than at Abbott’s headquarters. The third enterprise, the “ABcomm Enterprise,” tunneled kickbacks to physicians to increase Depakote prescriptions. The ABcomm Enterprise included physicians and other medical professionals, Abbott, and ABcomm, Inc: (“ABcomm"), a medical continuing education provider that created training materials and provided live activities. Abbott controlled and participated in each of these enterprises with the goal of increasing the amount of off-label Depakote prescriptions purchased by the TPPs.
Through these three enterprises, Abbott sponsored dinners and other programs where a physician would speak on off-label Depakote uses. Abbott directly or indirectly compensated the speaker, also paying for the meals of those physicians attending the dinners. Abbott funded physicians’ studies of Depakote, which served as a backdoor way of increasing Depakote prescriptions. Abbott also funded the development of clinical practice guidelines for De-pakote that mandated its use as a first-line of defense for dementia and long-term agitation and sundown syndrome in patients suffering from dementia. The guidelines did not disclose Abbott’s financial support, instead purporting to be independent. Similarly, Abbott issued supplements to medical journals disguised as peer-written articles free from' pharmaceutical manufacturer influence that promoted Depakote’s use for off-label indications.
In addition to working with these outside entities and physicians to promote off-label uses of Depakote, Abbott also had internal mechanisms in place to drive such sales. This included providing incentive packages to sales representatives based on their success in marketing Depakote. Abbott promoted standardized messaging among its sales representatives, providing them with scripts on how to sell physicians on prescribing Depakote for off-label uses. Abbott then had monthly contests for each
Abbott marketed Depakote for off-label uses despite having no reliable evidence of its safety or efficacy for the .treatment of these off-label conditions and, in some cases, having evidence that it was actually ineffective or unsafe for those conditions. For example, a study suspended in March 1999 for safety reasons “failed to show that Depakote was effective in treating the signs and symptoms of mania in elderly dementia patients.” Doe. '92 ¶ 60. Abbott also started but did not complete another clinical trial to evaluate Depakote’s safety and efficacy in treating agitation in elderly dementia patients in 2000' and received reports in May 2003 and December 2004 that Depakote made no meaningful difference in the treatment of elderly dementia patients when compared to a placebo group.
Nonetheless, Abbott persisted with its off-label marketing efforts. According to FDA projections, between March 2008 and February 2009, for retail outpatient Depa-kote prescriptions for patients over 61 years old, approximately 11% were associated with a schizophrenia diagnosis, 6.1% with a dementia diagnosis, and 5.4% with a depression diagnosis. Over the same time period, more than 12% of retail outpatient Depakote prescriptions for patients 17 years or older were associated with a schizophrenia diagnosis,- nearly 17% of retail outpatient Depakote prescriptions for patients between 12 and 16 years old were associated with an ADHD diagnosis, and 25% of retail outpatient Depakote prescriptions for patients between 17 and 20 were associated with conduct disturbance or impulse control disorder diagnoses. From March 2002 to February 2009, approximately 11.3% of retail outpatient De-pakote prescriptions for patients over 61 years old were associated with dementia, schizophrenia, or depression. During this same time period, nearly 9% of retail outpatient Depakote prescriptions written for patients 17 years or older were for schizophrenia- diagnoses.
Between 2007 and 2010, however, four sealed qui tarn actions were filed against Abbott pursuant to the False Claims Act, 31 U.S.C. § 3730(b), asserting illegal marketing of Depakote for non-FDA approved uses. On February 1, 2011, the qui tarn actions were unsealed as the United States and fifteen state governments intervened. Another state intervened two months later. After the consolidation of those actions, on May 7, 2012, Abbott agreed to pay $1.6 billion to resolve the criminal and civfi claims against it.
LEGAL STANDARD
A motion to dismiss under Rule 12(b)(6) challenges the sufficiency of the complaint, not its merits. Fed. R. Civ. P. 12(b)(6); Gibson v. City of Chicago,
Rule 9(b) requires a party alleging fraud to “state with particularity the circumstances constituting fraud.” Fed. R. Civ. P. 9(b). This “ordinarily requires describing the *who, what, when, where, and how’ of the fraud, although the exact level of particularity that is required will necessarily differ based on the facts of the case.” AnchorBank,
ANALYSIS
I. RICO Claims
The Funds assert that Abbott violated 18 U.S.C. § 1962(c) by conducting the affairs of the CENE Enterprise, the PharmaCare Enterprise, and the ABcomm Enterprise through patterns of racketeering activity. , To state a claim under § 1962(c), the Funds must demonstrate they have standing, as required by statute, and allege “(1) conduct (2) of an enterprise (3) through a pattern of racketeering activity.” DeGuelle v. Camilli,
In determining whether the Funds have adequately alleged proximate cause, the
Courts considering TPPs’ off-label RICO claims have reached differing conclusions as to whether the link between the alleged misrepresentations made by pharmaceutical company defendants and the ultimate injury suffered by TPP plaintiffs is sufficiently direct to meet RICO’s proximate cause requirement. Some courts have found that the chain of causation involves too many independent steps or actors. See, e.g., UFCW Local 1776 v. Eli Lilly & Co.,
The Funds argue that the distinction drawn by courts relying on direct and indirect misrepresentations is misplaced and that the proximate cause analysis should turn instead on foreseeability. See Bridge v. Phoenix Bond & Indem. Co.,
Having carefully reviewed the case law and the parties’ arguments concerning alleging proximate cause for prescription drug TPP RICO cases,, the Court agrees that a line must be drawn to “distinguish the direct consequences in a close,causal chain from more attenuated effects influenced by too many intervening causes.” Emp’r Teamsters-Local Nos. 175/505 Health & Welfare Trust Fund v. Bristol Myers Squibb Co.,
Where a drug manufacturer or supplier directly deceives a TPP into granting its drug favorable formulary status, the relationship between the misconduct and the harm is direct and immediate. Unlike in Holmes and Anza, the alleged misconduct (misrepresenting the safety and efficacy of a drug) is not wholly distinct from the injury (deciding to pay for the drug prescribed). Though other steps must occur for the payment to actually be madé—for example, physicians’ prescribing the drugs and patients’ filling the prescriptions—they do not interrupt the relationship between the manufacturers’ direct misrepresentations and the TPP’s resulting formu-lary decision.
Med. Mut. of Ohio,
Here, the Funds have not alleged that Abbott made direct misrepresentations to them so as to cause them to place Depa-kote on their formularies or pay for Depa-kote when prescribed. Indeed, they do not
Because the Funds have not adequately pleaded proximate causation, the Court dismisses the RICO claim. This means their RICO conspiracy claim under § 1962(d) fails as well. See United Food & Commercial Workers Unions & Emp’rs Midwest Health Benefits Fund v. Walgreen Co.,
II. State Law Claims
The Funds also bring claims for violation of the New York Deceptive Business Practices Act, New York Gen. Bus. Law § 349, and unjust enrichment under New York and Massachusetts law. Abbott argues that these claims fail for the same reasons the RICO claims fail, namely that the Funds have not pleaded cognizable injury, materially deceptive conduct, causation, or fraud in accordance with Rule 9(b)’s pleading requirements. Additionally, it contends the Court should dismiss the unjust enrichment claims because the Funds have an adequate remedy at law. Finally, Abbott resurrects its argument that the New York claims are time-barred, despite the fact that the Seventh Circuit reinstated the Court’s dismissal of the state law claims on statute of limitations grounds, binding this Court to that decision. See Sidney Hillman Health Ctr.,
Here, the Funds have pleaded that the Court has original jurisdiction over the RICO claims pursuant to 28 U.S.C. § 1331 and supplemental jurisdiction over the state law claims pursuant to 28 U.S.C. § 1367.
CONCLUSION
For the foregoing reasons, Abbott’s motion to dismiss [98] is granted. The Court dismisses the amended class action complaint without prejudice.
Notes
. In 2012, Abbott Laboratories split into two separate companies, Abbott Laboratories, focused on the development and sale of medical products, and AbbVie, Inc., focused on the development and sale of pharmaceuticals. AbbVie, Inc. currently sells and markets De-pakote in the United States, while Abbott Laboratories does so outside the United States. The Court will not differentiate between the two in this Opinion and Order.
. The Court previously dismissed the Funds’ complaint on statute of limitations grounds, Doc. 67, but the Seventh Circuit reversed that decision and remanded the case for further proceedings, Sidney Hillman Health Ctr. of Rochester v. Abbott Labs., Inc.,
.The facts in the background section are taken from the Funds' amended class action complaint and are presumed true for the purpose of resolving Abbott’s motion to dismiss. See Virnich v. Vorwald,
. Although not in the prescription drug context, the Seventh Circuit’s decision in International Brotherhood of Teamsters, Local 734 Health & Welfare Trust Fund v. Philip Morris Inc.,
. The Supreme Court denied GlaxoSmithK-line LLC’s petition for a writ of certiorari in Avandia on June 6, 2016. — U.S. —,
. The Funds also cite to United States ex rel. Brown v. Celgene Corp., No. CV 10-3165-GHK,
. The Funds do not plead -that diversity jurisdiction exists, and the Court cannot proceed on the assumption that it does. See Downs v. IndyMac Mortg. Servs., FSB,
