Seroquel Antitrust Litigation

An End-Payor Class Member, also known as a Third-Party Payor (“TPP”) Class Member, or an authorized agent can complete this Claim Form. If both a Class Member and its authorized agent submit a Claim Form, the Claims Administrator will consider only the Class Member’s Claim Form. The Claims Administrator may request supporting documentation in addition to the documentation and information requested below. The Claims Administrator may reject a claim if the Class Member or its authorized agent does not provide all requested documentation in a timely manner.

If you are a Class Member submitting a Claim Form on your own behalf, you must provide the information requested in “Section A – COMPANY OR HEALTH PLAN CLASS MEMBER ONLY,” in addition to the other information requested by this Claim Form.

If you are an authorized agent of one or more Class Members, you must provide the information requested in “Section B – AUTHORIZED AGENT ONLY,” in addition to the other information requested by this Claim Form. Do not submit a Claim Form on behalf of any other Class Member unless that Class Member provided you with prior written authorization to submit this Claim Form. Such written authorization must accompany this Claim Form.

If you are submitting a Claim Form only as an authorized agent of one or more Class Members, you may submit a separate Claim Form for each Class Member, OR you may submit one Claim Form for all such Class Members as long as you provide the information required for each Class Member on whose behalf you are submitting this Claim Form.

If you are submitting Claim Forms both on your own behalf as a Class Member AND as an authorized agent on behalf of one or more Class Members, you should submit one Claim Form for yourself, completing Section A, and another Claim Form or Claim Forms as an authorized agent for the other Class Member(s), completing Section B.

To qualify to receive a payment from the settlements, you must complete and submit this Claim Form either on paper or electronically, and you may need to provide certain requested documentation to substantiate your claim.

Your failure to complete and submit the Claim Form postmarked (if mailed) or received (if submitted online) on or before June 9, 2025, will prevent you from receiving payment from the settlements. Submission of this Claim Form does not ensure that you will share in payments related to the settlements. If the Claims Administrator rejects or reduces your claim, you may invoke the dispute resolution process described on pages 5 and 6 of the Claim Form.

CLAIM INFORMATION AND DOCUMENTATION REQUIREMENTS

Please provide information to support your claim of membership in the Class defined as follows:

All entities that, for consumption by their members, employees, insureds, participants, or beneficiaries, purchased, paid, and/or provided reimbursement for some or all of the purchase price of Seroquel XR or quetiapine fumarate ER 50 mg, 150 mg, 200 mg, and/or 300 mg tablets, other than for resale, in Arizona, Arkansas, California, the District of Columbia, Florida, Hawaii, Illinois, Iowa, Kansas, Maine, Maryland, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Oregon, Rhode Island, South Dakota, Tennessee, Vermont, West Virginia, or Wisconsin, at any time from September 5, 2015, through and until December 9, 2024.

The Class does not include the following:

1. Defendants and their subsidiaries and affiliates; and
2. Federal and state governmental entities.

The following information should be provided if you claim Class membership:

1. Name of TPP Class Member;
2. NDC number (a list of NDC numbers can be downloaded here)—e.g., 00000-0000-00; or Drug Name—e.g., Seroquel XR or generic quetiapine fumarate ER;
3. Fill date or date of purchase—e.g., 11/15/2015;
4. Location (State) of purchase—e.g., CA;
5. Location (State) of insured or beneficiary—e.g., CA; and
6. Amount billed (not including dispensing fee)—e.g., $123.50; and
7. Amount paid by the TPP net of co-pays, deductibles, and co-insurance—e.g., $118.50

If you are submitting a Claim Form on behalf of multiple Class Members, also provide the following information for each purchase or reimbursement:

1. Plan or Group Name; and
2. Plan or Group FEIN.

An exemplar spreadsheet containing these categories can be downloaded here. If possible, please use this format and provide the electronic data in Microsoft Excel, ASCII flat file pipe “|”, tab-delimited, or fixed-width format.

Transaction data supporting claims is mandatory. If, after an audit of your claim, the Claims Administrator still has questions about your claim and you have not provided sufficient substantiation of your claim, the Claims Administrator may reject your claim.

Please contact the Claims Administrator at 1-888-884-8072 with any questions about the required claims information or documentation. Please do not contact the Court concerning this matter.

Mail the completed Claim Form to the address below, along with any supporting documentation as described in the CLAIM INFORMATION AND DOCUMENTATION REQUIREMENTS above, postmarked on or before June 9, 2025, or submit the information online by clicking the “Start a Third-Party Payor Claim” button below by that date:

Claims Administrator
P.O. Box 5017
Portland, OR 97208-5017

Please click the button below to get started.