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203.

Moreover,

the

Defendant

Manufacturers

and

Omnicare

also

intentionally

and

materially omitted from their pitch to physicians that in many instances the switches cansed

substantial health risks to the elderly population. As a direct and proximate result of these

material misrepresentations and omissions, the prescribing physicians were induced to execute

PALs. Accordingly, the Defendant Manufacturers got what they paid for - a huge boost in

market share due to thousands of switches to the drugs that were often more expensive for

payors, creating a ready pool of additional revenues the Defendant Manufacturers used to fund

the kickbacks to Omnicare.

204.

The end result of the PAL scheme dramatically increased the number of claims

submitted to the government for the higher priced, "preferred" medications, which led to

dramatically

higher

revenue

for

the

Defendant

Manufacturers.

Thus

the

Defendant

Manufacturers' increased revenues, and the correspondingly-increased cost to the government

healthcare programs, were the direct, intended, and foreseeable result of the unlawful kickbacks

to Omnicare and the business plans that the Defendant Manufacturers developed in concert with

Omnicare to maximize the number of switches.

205.

Had

the

prescribing

physicians

known

the

truth

-

that

Omnicare

advocated

switches to the Defendant Manufacturers' preferred medications purely for financial gain and

without medical justification - the prescribing physicians would not have executed the PALs.

206.

The prescribing physicians reasonably and justifiably relied upon the consulting

pharmacists' misrepresentations. The law and ethical rules impose upon pharmacists the duty to

disclose all material facts relating to drug switching in order for physicians to make fully

informed decisions and to recommend drug switching based solely upon their independent

medical judgment that the switch would be in the particular patient's best interest.

57

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