e-Journal Summary

e-Journal Number : 84498
Opinion Date : 10/10/2025
e-Journal Date : 10/21/2025
Court : U.S. Court of Appeals Sixth Circuit
Case Name : Academy of Allergy & Asthma in Primary Care v. Amerigroup TN, Inc.
Practice Area(s) : Business Law
Judge(s) : Murphy, Sutton, and Kethledge; Concurrence – Kethledge
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Issues:

Antitrust; Claims under §§ 1 & 2 of the Sherman Act; Private right of action; 15 USC § 15(a); “Standing”; “Proximate causation”; Apple Inc v Pepper; Illinois Brick Co v Illinois

Summary

The court held that plaintiff-United Allergy’s Sherman Act claims against defendants-insurers and an allergy-care medical group were properly dismissed because plaintiff, as an “indirect seller,” was unable to establish proximate cause. United Allergy provides allergy supplies and personnel to primary-care physicians. It sued defendants for antitrust violations under §§ 1 and 2 of the Sherman Act, seeking treble damages for allegedly conspiring to drive it and its contracting doctors out of the market. The district court dismissed United Allergy’s antitrust claims on the pleadings for lack of standing. On appeal, like the district court, the court concluded “that United Allergy has alleged only indirect injuries that flow out of the harms the defendants inflicted on physicians.” But it instead characterized “this defect as a lack of causation rather than ‘standing.’” A plaintiff suing under the antitrust laws “must show both that it suffered an antitrust injury and that the defendant proximately caused the injury. United Allergy’s suit flunks the latter element.” The court noted that the Supreme Court, relying on proximate causation principles, “has held ‘that indirect purchasers who are two or more steps removed from [an antitrust] violator in a distribution chain may not sue.’” The court found “the same rule should apply in reverse to indirect sellers for antitrust violations that a group of buyers (like the insurers here) commit. United Allergy is also an indirect seller because it is ‘two’ ‘steps removed from’ the insurers in the distribution chain. The insurers directly bought from (and harmed) the primary-care physicians by allegedly conspiring to fix their reimbursement rates and deny their claims. And that conduct harmed United Allergy only indirectly because it led the physicians not to pay United Allergy’s fees and to end their relationship.” Affirmed.

Full PDF Opinion