The SaveOnSP lawsuit landscape has two centers of gravity: a 2022 case brought by Johnson & Johnson in New Jersey federal court alleging that SaveOnSP’s copay maximizer program cost it more than $100 million in excess CarePath payments, and a December 2024 patient class action in the Western District of New York accusing SaveOnSP, Express Scripts, and Accredo of running a racketeering enterprise that has diverted “hundreds of millions, if not billions, of dollars” of manufacturer copay assistance meant for sick patients. Both cases remain active in mid-2026, and neither has reached a ruling on the merits.
What SaveOnSP Actually Does
SaveOnSP advises self-funded employer health plans to reclassify certain expensive specialty drugs as “non-essential health benefits” under the Affordable Care Act. That label is the whole engine. The ACA caps what patients pay out of pocket each year for essential health benefits, but a drug tagged non-essential falls outside those caps, and the plan can set the copay wherever it wants.
SaveOnSP sets it to match the maximum annual value of the manufacturer’s copay assistance program. If Johnson & Johnson offers up to $20,000 a year through CarePath, the plan sets the patient’s copay at or near $20,000. The manufacturer’s fund pays it. The patient pays nothing for the drug itself. The plan spends none of its own money.
None of that assistance money counts toward the patient’s deductible or annual out-of-pocket maximum. Patients who would otherwise hit their cost-sharing ceiling early in the year keep paying full price for doctor visits, lab work, and imaging for the rest of the year.
According to court filings, SaveOnSP runs the program with Express Scripts, the pharmacy benefit manager owned by Cigna’s Evernorth Health subsidiary, and Accredo, Express Scripts’ specialty pharmacy. Express Scripts markets the arrangement to plan sponsors, SaveOnSP administers it, and Accredo handles enrollment and dispensing. The three companies reportedly keep 25% of the redirected assistance funds; the remaining 75% offsets the employer plan’s drug costs.
The Johnson & Johnson Case
Johnson & Johnson Health Care Systems filed suit against SaveOnSP on May 4, 2022, in the U.S. District Court for the District of New Jersey (Case No. 2:22-cv-02632). The complaint alleged tortious interference with contract and deceptive trade practices under New York business law. J&J argued that SaveOnSP causes patients to breach the terms of CarePath, which bars participants from enrolling in other assistance programs at the same time, and that SaveOnSP enlisted pharmacies to reject claims and concealed from patients that enrollment would violate their CarePath agreements.
CarePath advertises up to $20,000 per patient per year, and under normal use only a small percentage of patients exhaust the full amount. J&J alleged that SaveOnSP’s program was engineered to drain every available dollar, costing the manufacturer over $100 million in extra payments. In response, J&J cut its CarePath benefit from $20,000 to $6,000 per patient for Stelara and Tremfya, effective January 2022, for patients enrolled in plans that use programs like SaveOnSP’s.
Motion to Dismiss Denied
SaveOnSP moved to dismiss. On January 25, 2023, Judge John Michael Vazquez denied the motion in full. On the tortious interference claim, the court rejected SaveOnSP’s argument that no contract existed at the time of the alleged interference; because patients agree to CarePath’s terms each time they use the program, and J&J alleged breach with each use, a contractual relationship was sufficiently pleaded. On the deceptive trade practices claim, the court found J&J had alleged a direct injury, being forced to pay more from its assistance funds than it otherwise would, rather than a derivative consumer injury. The judge noted that amicus briefs from seven patient advocacy organizations, including Aimed Alliance, Triage Cancer, and the HIV+Hepatitis Policy Institute, “contributed to the Court’s understanding of the public harm” from the program.
SaveOnSP also raised an ERISA preemption defense, arguing the state-law claims effectively sought to regulate ERISA-governed plans. Applying the Supreme Court’s functional test from Rutledge v. Pharmaceutical Care Management Association, the court concluded the claims did not have an impermissible connection to an ERISA plan because relief would not require interpreting plan provisions or mandating changes to plan terms.
Current Status
On October 2, 2024, J&J filed an amended complaint adding Express Scripts and Accredo as defendants and demanding a jury trial. As of mid-2026, the case is deep in discovery. A retired judge, Hon. Freda L. Wolfson, is serving as special master to manage discovery, and 2025 saw repeated motions to compel, motions to quash, and disputes over custodians and interrogatories. No summary judgment motion has been filed, and no trial date has been set.
The Gurwitch Class Action
On December 26, 2024, Annabelle Gurwitch, diagnosed with stage 4 lung cancer in 2020 and prescribed the specialty drug Tagrisso, filed a class action complaint against SaveOnSP, Express Scripts, and Accredo. The case was initially filed in the Northern District of New York and transferred on January 3, 2025, to the Western District of New York (Case No. 1:25-cv-00006-LJV).
Her lawyers at Lockridge Grindal Nauen call the operation the “SaveOnSP Copay Assistance Fraud Enterprise.” The complaint alleges the trio systematically coerced patients into the program by threatening them with inflated copays and, according to the allegations, having Accredo tell patients who refused to enroll that their prescription claims had been rejected while withholding their medications.
ERISA Claims
The ERISA theory argues that SaveOnSP, Express Scripts, and Accredo function as plan fiduciaries and breach their duties by failing to credit copay assistance toward patients’ annual cost-sharing limits, issuing prescription claim denials without proper notice, instructing patients to misrepresent their circumstances to manufacturer assistance programs, and operating the program to benefit themselves rather than patients.
RICO Claims
The RICO allegations describe a pattern of mail and wire fraud built on five elements: bypassing ACA cost-sharing limits by misclassifying essential medications as non-essential; inflating copays to drain manufacturer assistance; coercing patients into enrollment; diverting funds to plan sponsors while keeping a quarter for the enterprise; and forcing patients to pay full price for other medical care they would not otherwise owe. The complaint seeks treble damages under RICO and injunctive relief under ERISA to shut the program down.
Class Size
The amended complaint, filed January 8, 2025, estimates that roughly 52.3 million patients receive benefits through participating health plans. Based on SaveOnSP’s own marketing materials, about 1.4% of those patients are identified as “targeted patients,” yielding an estimated class exceeding 732,000 members. As of mid-2026, the case is in its early stages and no merits rulings have issued.
A Parallel Case Against PrudentRx
Lockridge Grindal Nauen filed a companion suit the same day. In Gluesing v. PrudentRx LLC & Caremark Rx LLC (Case No. 1:24-cv-00549, D.R.I.), plaintiff Sheila Gluesing alleges a virtually identical scheme by PrudentRx working with CVS’s Caremark and CVS Specialty Pharmacy. The complaint brings the same ERISA and RICO claims and alleges PrudentRx automatically enrolls patients, sets a 30% coinsurance rate, extracts the full manufacturer assistance amount, and keeps 25%. The parallel filing signals a litigation strategy aimed at the copay maximizer model itself rather than one vendor.
Why the ACA Rules Matter
Whether these programs are lawful turns partly on how federal agencies interpret the ACA’s cost-sharing rules, and that interpretation has swung back and forth. CMS issued guidance in 2020 requiring plans to count manufacturer copay assistance toward patients’ out-of-pocket limits for drugs without a medically appropriate generic. In 2021, CMS reversed itself and gave plans full discretion to exclude that assistance regardless of whether a generic existed, effectively clearing the way for copay accumulator and maximizer programs.
Patient advocacy groups sued. In September 2023, Judge John Bates of the U.S. District Court for the District of Columbia struck down the 2021 rule in HIV and Hepatitis Policy Institute v. HHS, holding it arbitrary and capricious and in conflict with the ACA’s definition of cost sharing. The government appealed, then withdrew the appeal in January 2024, leaving the 2020 rule technically back in effect. HHS has not enforced it since. According to the HIV+Hepatitis Policy Institute, an estimated 43% of commercial insurers were still using copay accumulator programs as of 2024. The 2026 proposed NBPP rule did not address cost-sharing definitions.
State laws requiring insurers to count copay assistance toward cost sharing exist in at least 25 states, the District of Columbia, and Puerto Rico, but those laws generally reach only state-regulated plans, not the self-funded employer plans where SaveOnSP operates.
The Standing Hurdle Patients Face
Patients suing over these programs have run into a recurring problem: proving concrete, traceable, redressable injury for Article III standing. In Lewandowski v. Johnson & Johnson, a plan participant sued J&J as plan sponsor, alleging fiduciary breaches around PBM oversight. On November 26, 2025, the District of New Jersey dismissed the claims for lack of standing, finding the link between PBM fees and what participants actually paid in premiums and out-of-pocket costs “too tenuous” and “speculative.” Because J&J had sole discretion to set contribution rates, the court reasoned, lower PBM costs would not necessarily flow through to employees. The plaintiff filed a notice of appeal in January 2026.
Gurwitch’s case is structured to avoid that trap. It sues the PBM and the copay maximizer directly rather than the plan sponsor, and it frames the harm not as speculative premium effects but as the direct diversion of manufacturer assistance funds and the resulting out-of-pocket costs patients pay for other medical care once their deductibles never get credited.