August 1, 2022
After starting a career in advertising working with the voice of Darth Vader, Christina Saler made a pivot into law school and has since dedicated her professional life to rooting out corporate wrongdoing.
Saler, a partner at Cohen Milstein, focuses primarily on shareholder litigation, representing public pension funds and other institutional investors as plaintiffs in class actions against publicly traded corporations and their officers and directors for securities fraud or breaches of fiduciary duty.
One of her current cases is centered around the pricing of prescription medicine. Working with the Ohio Attorney General, Saler and her team have been able to uncover the machinations of pharmaceutical middlemen that have allegedly kept prices of pharmacy drugs artificially high.
While this is something of a departure from her securities work, the prescription pricing cases fit into her ethos and reasoning behind practicing law, which is all about bringing transparency, accountability and lasting change for the public good.
A graduate of Rutgers University Law School, Saler is a Lawdragon 500 Leading Plaintiff Financial Lawyer.
Lawdragon: What do you like most about your practice?
Christina Saler: Over the years, I have forged many long-lasting relationships with the professionals and trustees entrusted with administering and overseeing pension funds for public employees and unionized workers. The public pension fund community is a collegial group with a tremendous responsibility – safeguarding the retirement money for teachers, firefighters, police officers, other public servants and members of trade unions. So I feel honored to have become a trusted client counselor.
LD: What types of matters are keeping you busy these days?
CS: Since 2017, there has been a growing concern about how Pharmacy Benefit Managers (PBMs) have used their position to affect the pricing and availability of prescription drugs. As you can imagine, this is a big concern for state-funded health plans, such as Medicaid and public employee plans, since healthcare costs tend to be one of the largest line items in a state budget.
PBMs provide prescription drug benefits and services to private health insurance plans, self-insured employers and state-run programs. You can think of them as “middlemen” because they negotiate with drug manufacturers on the cost of drugs that will be covered by the PBMs’ health plan clients, and they negotiate with pharmacies the costs to fill the prescriptions. PBMs also develop their own pharmacy networks. Currently, three PBMs – CVS Caremark, Express Scripts and OptumRx – control nearly 80 percent of the prescription drug market and operate with little transparency or accountability to states and consumers.
Independent pharmacists were the first to raise a public outcry about PBMs’ unfair and potentially fraudulent business practices. The pharmacists were feeling financially squeezed. But PBMs’ business practices weren’t only harming independent pharmacies. Our investigations on behalf of state attorneys general across the country have revealed that some PBMs’ abusive drug pricing and fee layering schemes cost many states hundreds of millions of dollars in fraudulent charges.
The complexity of the PBM industry cannot be understated; many of the major players are vertically integrated companies, meaning that a single holding company has wholly owned subsidiaries that are health plan insurers, MCOs, PBMs and/or retail pharmacy chains.
Although working in this space was a shift from my securities practice, it’s because of the strong relationships that I’ve forged over the years that I was in position to help lead this highly specialized work, starting in 2018 as special outside counsel to the Office of the Ohio Attorney General. Since then, our work has expanded considerably. So, right now, we represent many state attorneys general in their investigations of the PBMs servicing their states, have active litigation against OptumRx and Express Scripts in one state, and have settled several matters on behalf of some of these states against Centene Corporation, which is the largest provider of managed care services to state Medicaid programs. We have joined forces with a highly talented small firm in this massive effort. Together, we really are the only ones doing this type of work on behalf of the states.
Our investigations on behalf of state attorneys general across the country have revealed that some PBMs’ abusive drug pricing and fee layering schemes cost many states hundreds of millions of dollars in fraudulent charges.
LD: This sounds like it could have massive implications. How did you first start working with the Ohio AG on this?
CS: In 2018, we were retained by Ohio Attorney General Dave Yost’s Office to assist in his investigation of the State of Ohio’s PBM relationships. Among the Ohio agencies and entities requiring PBM services are the Ohio Medicaid program, which is overseen by the Ohio Department of Medicaid (ODM), the Ohio Bureau of Workers Compensation (BWC), the Ohio Department of Administrative Services (DAS) and the Ohio Highway Patrol Retirement System.
LD: What’s the current status of the cases?
CS: We have two matters in active litigation. Trial against OptumRx is currently set for October 2022. It was, however, the ODM litigation against Centene Corp. filed in March 2021 that was a watershed case.
LD: Tell us about that one.
CS: Ohio’s Medicaid program provides coverage to about 2.9 million Ohioans through Managed Care Organizations (MCOs). One such MCO, Centene’s Buckeye Health Plan, administered its pharmacy benefits and services via its captive PBM, Envolve Pharmacy Solutions. Working closely with the AG’s office, we conducted an extensive investigation and alleged that Centene’s MCO and PBM entities had breached Centene’s provider agreements with ODM, violating Ohio’s statutory law which governs the practices of MCOs.
Three months after we filed the case, on June 14, 2021, AG Yost announced that the litigation was resolved by a $88.3M settlement with Centene Corporation. The settlement, one of the largest in Ohio history, sent a message to PBMs nationwide that they cannot take advantage of the state or patients.
This victory in Ohio was just the start. Since June 2021, we have negotiated nine individual state settlements with Centene worth more than $360M to resolve investigations we had been conducting for those states, and we are working on finalizing several others.
LD: Congratulations. Can you talk about some of the challenges of managing a collection of cases of this magnitude?
CS: These are large, highly complex data- and contract-driven cases which require specific expertise in Medicaid regulations, drug pricing and claims data analysis. So we needed to not only become experts ourselves in this area of the law and fluent in the business practices PBMs deploy, but also assemble a team of industry and data experts to help identify any irregularities in the PBMs’ pricing of drug claims, processing and reporting to the states. Our investigations require a lot of coordination with our clients, too. In addition to working with the state AG’s offices, we also interact with the state agencies that procured the PBMs and utilize their services.
LD: What impact are these efforts having on the industry?
CS: Our work with state attorneys general has put pressure on PBMs. They are fully aware that states are scrutinizing these extraordinarily expensive contracts – and state legislatures are also focusing on the business practices that have put independent pharmacies out of business while PBM profits increased year-after-year. Also, at the federal level, the Federal Trade Commission launched an inquiry into PBMs on June 7, 2022. The FTC’s probe will scrutinize the impact of vertically integrated PBMs on the access and affordability of prescription drugs.
Litigation is an effective way to return money to the states that PBMs improperly charged. But I think legislation is the ultimate long-term solution. These two tools combined are bringing transparency to the industry that should, over time, bring down the cost of drugs to states and individual consumers.
LD: Was there an early experience or mentor who really helped shape the course of your professional life?
CS: I had a wonderful mentor named George Croner at Kohn Swift & Graft, which I joined fresh out of law school. George had attended the U.S. Naval Academy and, when he was in the Navy, he was the guy waving the jets onto the carrier runway. That guy! We worked on a lot of fiduciary duty shareholder rights cases in the context of limited partnerships, as well as a few interesting defamation lawsuits we took to trial against media defendants. George is retired now but was a very practical litigator and a brilliant writer. He took me under his wing and gave me a tremendous amount of responsibility and opportunities as a young associate.
I’m focused on relationships and helping investors and other clients address their losses through litigation in a pragmatic way. I think the “scorched earth” approach to litigation can be very destructive.
When I joined Cohen Milstein in 2017, I had already been practicing for 14 years. I had my own portfolio of work, clients, etc. So, my interests and goals were different. Cohen Milstein is very well known in the institutional investor and public pension community, so the firm offered a significantly bigger platform than I had before, which allowed me to broaden my representation of the clients I brought to the firm. Steve Toll, the managing partner of Cohen Milstein and Lawdragon Legend who brought me to the firm, has been incredibly supportive of my work, especially in developing the PBM matters. I respect his opinion and trust his assessment of delicate matters that have arisen as we’ve worked with the various states. I feel fortunate that I had George to guide me in my early career, and Steve to consult with in the latter part of my career.
LD: How would you describe your style as a lawyer? Or, how do you think others see you?
CS: I think my adversaries see me as very prepared and direct. I’m focused on relationships and helping investors and other clients address their losses through litigation in a pragmatic way. I think the “scorched earth” approach to litigation can be very destructive. Likewise, grandstanding or trying to come across as the smartest person in the room is incredibly unproductive and asserts the lawyers’ personal interests over the clients. Instead, what I strive to do is communicate clearly, build trust and methodically plan a strategy while remaining flexible. I think all of that is critical to the endgame in part because it advances the case and earns respect from opposing counsel and the bench.
LD: If you weren’t a lawyer, what would you be doing now?
CS: I’d be an entertainment agent. Seriously, I was heading in that direction. My first career was in advertising. Before going to law school in 2000, I worked at Tierney, an advertising and public relations agency based in Philadelphia. Our largest client was Bell Atlantic, which merged with GTE Corp. to become Verizon. I managed several creative campaigns, but my primary focus was managing the company’s expansive spokesperson contract with James Earl Jones. Yes, the voice of Darth Vader! In the 1990s, James Earl Jones was the voice and the face of Bell Atlantic, a role he continued to play for Verizon when the companies merged in 1999.
I worked very closely with James Earl for several years, reviewing all the creative and scripts for commercials, contracts, scheduling, personal appearances – everything had to go through me. We spent a lot of time together at the voiceover studio and on shoots, and we developed a great professional relationship and friendship. Of course, best laid plans. I met my husband when I was applying to law schools. He is a lobbyist, and I quickly became immersed in his political network. So, in law school my focus changed to working with public sector clients to get them relief when corporations play too fast and loose with the law.