Please type or print in the box below, the total amount paid or reimbursed for Brand and authorized generic EpiPens, net of co‐pays, deductibles, and
co‐insurance, between August 24, 2011, and November 1, 2020, inclusive.
Please note that certain groups have been excluded from the Class in this case.
Do not submit a claim for or on
behalf of any of the following excluded groups
a. Pfizer Inc., Meridian Medical Technologies, Inc., King Pharmaceuticals, Inc. (n/k/a King Pharmaceuticals LLC), Mylan N.V., Mylan Specialty L.P.,
Mylan Pharmaceuticals Inc., Viatris, Inc., and their officers, directors, managers, employees, subsidiaries, and affiliates (collectively, the “Defendants”)
b. Government entities, other than government-funded employee benefit plans;
c. Fully insured health plans (i.e., plans that purchased insurance that covered 100% of the plan’s reimbursement obligations to its members);
d. Entities that purchased Branded or generic EpiPens directly from one or more of the Defendants;
e. All third-party payors who own or otherwise function as a Pharmacy Benefit Manager or control an entity who functions as a Pharmacy Benefit Manager; and
f. Any entity that previously opted out of the Class in this action.