Healthcare Antitrust, Settlements, and the Federal Trade Commission: Volume 28

The Federal Trade Commission (FTC) has initiated policies and legal challenges that have shaped the evolution of competition in healthcare. This chapter discusses not only discusses the current matters in healthcare competition, but it also gives a history of past issues faced by the FTC and the approaches used to resolve them. These FTC actions range from challenges to hospital mergers to preventing “reverse payments” from patent holders to generic entrants in pharmaceuticals. Ultimately the healthcare industry faces many unique regulatory and competitive aspects that, while challenging, do not require special rules.

The Supreme Court’s decision in Federal Trade Commission v. Actavis, Inc. is a challenge to conventional antitrust analysis. Conventional civil antitrust cases are decided by a preponderance of the evidence. This means that conduct challenged under the rule of reason is only condemned if the conduct resulted in more competitive harm in the actual world than a world without the alleged violation. Under conventional analysis, the intent of the parties also plays only a supporting role in determining whether the conduct was anticompetitive. A holder of a valid patent has a right to exclude others practicing the patented technology. And, the patent holder is not assumed to have market power because it expended resources in maintaining exclusionary rights. Actavis creates doubts about these propositions in circumstances beyond the “reverse” payment settlement of a patent suit that may have delayed an alleged infringer market entry. This chapter explores whether applying Actavis logic to antitrust litigation can result in condemnation of practices where there is little chance of an anticompetitive effect, where the patent holder likely has a valid and infringed patent, where there is little reason to believe that the patent holder has market power, and where only one party, or no parties, to an agreement have an anticompetitive intent. This chapter also investigates whether Actavis creates new problems with standing analysis, damages calculations, and the balancing of efficiencies against anticompetitive effects. Nevertheless, the lower courts have begun to extend the logic of Actavis. This is apparent in the condemnation of no-Authorized-generic settlements.

Brand-name pharmaceutical companies have engaged in a variety of business conduct that has increased price. One of these activities involves “product hopping,” or brand switches from one version of a drug to another. The antitrust analysis of product hopping implicates antitrust law, patent law, the Hatch–Waxman Act, and state drug product selection laws, as well as uniquely complicated markets characterized by buyers different from decision makers. As a result, courts have offered inconsistent approaches to product hopping.

In this chapter, we offer a framework that courts and government enforcers can employ to analyze product hopping. The framework is the first to incorporate the characteristics of the pharmaceutical industry. It defines a “product hop” to include instances in which the manufacturer (1) reformulates the product to make the generic nonsubstitutable and (2) encourages doctors to write prescriptions for the reformulated rather than the original product.

When the conduct meets both requirements, our framework offers two stages of analysis. First, we propose two safe harbors to ensure that the vast majority of reformulations will not face antitrust review. Second, the framework examines whether the hop passes the “no-economic-sense” test, determining if the behavior would make economic sense if the hop did not have the effect of impairing generic competition. Showing just how far the courts have veered from justified economic analysis, the test would recommend a different analysis than that used in each of the five product-hopping cases that have been litigated to date, and a different outcome in two of them.

This chapter assesses the doctrine of reasonable interchangeability through the lens of the US Department of Justice’s (DOJ’s) successful effort to enjoin the megamerger of two of the largest national insurance companies, Aetna and Humana. The DOJ focused its challenge on the companies’ Medicare Advantage business, arguing that it is a separate product market from original Medicare and the merger would substantially reduce competition in the market for Medicare Advantage in many geographic markets across the country. The case turned on whether there was reasonable interchangeability between original Medicare and Medicare Advantage in the eyes of consumers. The judge relied on both practical indicia of interchangeability, including evidence of how likely Medicare beneficiaries were to switch between Medicare Advantage and Original Medicare, along with econometric evidence. The decision provides a useful roadmap of how a knowledgeable judge reviewing a merger will consider both Brown Shoe factors and econometric evidence in assessing reasonable interchangeability.

The Bureau of Economics in the Federal Trade Commission has a three-part role in the Agency and the strength of its functions changed over time depending on the preferences and ideology of the FTC’s leaders, developments in the field of economics, and the tenor of the times. The over-riding current role is to provide well considered, unbiased economic advice regarding antitrust and consumer protection law enforcement cases to the legal staff and the Commission. The second role, which long ago was primary, is to provide reports on investigations of various industries to the public and public officials. This role was more recently called research or “policy R&D”. A third role is to advocate for competition and markets both domestically and internationally. As a practical matter, the provision of economic advice to the FTC and to the legal staff has required that the economists wear “two hats,” helping the legal staff investigate cases and provide evidence to support law enforcement cases while also providing advice to the legal bureaus and to the Commission on which cases to pursue (thus providing “a second set of eyes” to evaluate cases). There is sometimes a tension in those functions because building a case is not the same as evaluating a case. Economists and the Bureau of Economics have provided such services to the FTC for over 100 years proving that a sub-organization can survive while playing roles that sometimes conflict. Such a life is not, however, always easy or fun.

This chapter focuses on dispute resolution in French labor courts. We empirically investigate the forces that shape decision-making in the pretrial conciliation phase. For that purpose, we compiled a new database from legal documents. The results are twofold. First, conciliation is less likely when plaintiffs are assisted by a lawyer. Although this result might be interpreted in various ways, further analysis shows that the lawyers’ remuneration scheme is the most likely cause of this effect. Second, we find that the likelihood of settlement decreases as the amount at stake increases. These results contribute to the ongoing debate about French labor court reform.

In this chapter, using a dual approach based on managerial and legal perspectives, we examine franchisee attitudes regarding online sales in franchise networks to better understand their views of the costs and benefits of e-commerce in a franchise network. We thus explore the following research questions from a franchisee perspective: What are franchisees’ attitudes regarding online sales?; Are online sales viewed as complementary or competing sales for physical stores?; What about the opening of a franchisor’s website?; and What about the opening of a franchisee’s website? We also analyze how several different e-commerce options available to franchisors impact franchisee incentives and how they would be treated under European Union competition law.

The empirical research is based on the conduction and analysis of 46 in-depth interviews with franchisees in the retail and service industries in the French market.

We find that online sales in franchise networks raise important questions for the franchisees, and for the franchisors as well. E-commerce has to be integrated into the development strategies of franchise networks. Franchisors should facilitate the online sales practices of their franchisees in order to avoid potential conflicts with them or among the franchisees themselves, thereby maintaining the control necessary to ensure healthy network growth. Moreover, franchisors should pay attention to the sharing of Internet sales with its franchisees.

Our chapter contributes to the stream of franchising literature dealing with the use of Internet in franchise networks. Moreover, it can be viewed by franchisors, franchise experts, franchisees, and franchisee candidates as an overview of issues linked to online sales in franchise networks. It also highlights best practices when having a multichannel strategy.

The competition and regulatory economics literature has developed indicators that detect whether a vertically integrated provider (VIP) is engaging in market exclusion in the form of an anticompetitive price squeeze and non-price discrimination leading to sabotage of downstream competitors. Weisman integrates these indicators by developing a safe-harbor range within which a profit-maximizing VIP engages in neither form of market exclusion. Downstream retail competition that depends on the VIP’s inputs imposes upward pricing pressure on the downstream prices, with the amount of such pressure increasing as the downstream products become more homogeneous (closer substitutes). We analyze the implications of upward pricing pressure for antitrust evaluations of a duty to deal, regulatory policies mandating wholesale inputs for entrants, and vertical mergers. We find, for example, no basis to oppose a merger in which the VIP was previously required to supply inputs to rivals at unregulated prices.

In regressions using a semi-logarithmic functional form that include a dummy variable, Kennedy (1981) showed that instead of interpreting the dummy coefficient directly, one needs to “correct” it to estimate the percentage effect of the dummy variable on the dependent variable. In the context of an antitrust application, we show that when using a dummy variable to estimate the overcharge as a percentage of the actual price, one should not apply the correction proposed by Kennedy because doing so will lead to an overcharge estimate with a larger bias.

John Kwoka’s Mergers, Merger Control, and Remedies is a meta-analysis of “retrospective” academic studies of consummated mergers and other horizontal arrangements. Based on this meta-analysis, Kwoka strongly criticizes federal enforcement policies, claiming that the agencies permit far too many anticompetitive mergers to go unchallenged, and are far too willing to accept remedies that fail to prevent a significant loss of competition. Kwoka claims further that this excessive leniency is the culmination of a trend reflecting deliberate policy choices made over the last several decades.

In a forthcoming critique, Vita and Osinski challenge Kwoka’s analysis and his conclusions, identifying serious flaws in the size, construction, and composition of his sample, and in the statistical analysis of the data drawn from that sample. In a published response to Vita and Osinski, Professor Kwoka offers a number of objections and counter-arguments. In this rejoinder, I respond to Professor Kwoka.