Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-alnd-2_13-cv-20000/USCOURTS-alnd-2_13-cv-20000-10/pdf.json

Nature of Suit Code: 890
Nature of Suit: Other Statutory Actions
Cause of Action: 28:1331 Fed. Question

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IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ALABAMA

SOUTHERN DIVISION

}

IN RE: BLUE CROSS BLUE SHIELD } Master File No.: 2:13-CV-20000-RDP

ANTITRUST LITIGATION }

 (MDL NO.: 2406) }

}

MEMORANDUM OPINION AND ORDER ON DEFENDANTS’ MOTION REGARDING 

THE ANTITRUST STANDARD OF REVIEW APPLICABLE TO PROVIDER 

PLAINTIFFS’ SECTION 1 CLAIMS PURSUANT TO FEDERAL RULE OF CIVIL 

PROCEDURE 56

This matter is before the court on Defendants’ Motion Regarding the Antitrust Standard of 

Review Applicable to Provider Plaintiffs’ Section 1 Claims. (Doc. # 2722). The Motion has been 

fully briefed. (Docs. # 2728; 2747; 2772).

This multi-district litigation has now entered its tenth year. But, even at this advanced stage 

of the litigation, the court has not had the occasion to address “whether the Blue Plans’ service 

area allocations alone constitute a per se violation of Section 1.” (Doc. # 2063 at 37). That is 

because in the court’s April 2018 standard of review opinion (Doc. # 2063), the record before the 

court presented it with “an aggregation of competitive restraints,” which included the National 

Best Efforts (“NBE”) rule. The court concluded that combination of restrictions was to be analyzed 

under the per se rule. (Id.). However, in April 2021, in connection with the settlement between the 

Subscriber Plaintiffs and the Blues, Defendants eliminated the NBE rule.

1

(Doc. # 2735-33). The 

question now presented is whether the elimination of the NBE rule distinguishes this matter from 

1 Defendants agreed as part of the settlement to eliminate the NBE rule, but did not await final approval and 

unilaterally implemented that change in practice last year.

FILED

 2022 Aug-09 PM 12:28

U.S. DISTRICT COURT

N.D. OF ALABAMA

Case 2:13-cv-20000-RDP Document 2933 Filed 08/09/22 Page 1 of 13
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the aggregation of competitive restraints found in Sealy2and necessitates a further analysis of

Topco.

3 The answer is “yes.” As explained in more detail below, the court concludes that 

Defendants’ new system is distinguishable from Sealy and Topco and that, for the period following 

the elimination of the NBE rule (i.e., after April 2021), and for purposes of determining (or 

evaluating) any structural relief, it must apply the rule of reason analysis to Providers’ Market 

Allocation Conspiracy claims. 

In their Motion, Defendants argue that the appropriate antitrust standard of review for 

Providers’ challenges to the Blue Plans’ Exclusive Service Areas (“ESAs”) (their Market 

Allocation Conspiracy claims) is the rule of reason, and that ESAs, alone, are not subject to the 

per se rule for two primary reasons. First, Defendants contend that without NBE, there is no longer 

an “aggregation of competitive restraints” similar to that addressed in the court’s April 2018 

standard of review opinion. (Doc. # 2728 at 10). Second, Defendants assert that Providers’ claims 

have “never involved an aggregation of restraints on branded and unbranded business.” (Id.). 

Providers respond that (1) the elimination of NBE does not affect the standard of review 

for the Providers’ claims from 2008 (the beginning of the limitations period) to April 2021 (when 

NBE was eliminated), and (2) because Providers still seek injunctive relief to remedy the ongoing 

effects of the NBE rule, the ESA and NBE rules can still be viewed in tandem for purposes of 

determining the standard of review. (Doc. # 2747 at 6). Providers further argue that ESAs did not 

“develop independently through existing trademark rights,” and, even if they did, their historical 

origin makes no difference to the standard of review, as there is still “no daylight” between the 

facts of this case and the Supreme Court’s decisions in Topco and Sealy. (Doc. # 2747 at 17, 19).

2 United States v. Sealy, 388 U.S. 350 (1967).

3 United States v. Topco Associates, Inc., 405 U.S. 596 (1972).

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In their reply, Defendants assert that it was permissible to settle their trademark rights and 

protect their trademarks through the license agreements containing the ESAs, and that alone 

defeats per se treatment. (Doc. # 2772 at 6). Defendants further argue that a determination about 

the legal effect of their ESAs, standing alone, implicates the rule of reason because they arose in a 

novel factual context and offer procompetitive efficiencies. (Id.). Finally, Defendants argue that 

the court’s April 2018 standard of review decision should not apply to Providers’ claims against 

them because it was a Subscriber-focused ruling made at a time when the Subscriber and Provider 

cases were joined, and Providers have no viable claim related to NBE. (Id.). 

I. Background

The Blue Plans historically began with the development of prepaid hospital and medical 

plans in the 1930s. (Docs. # 1353-4 at 21-22; 24; 1353-10 at 8-9). Local plans began using the 

Blue Cross or Blue Shield symbol: the Blue Cross for prepaid hospital care was first used by the 

St. Paul, Minnesota Plan in 1934; and the Blue Shield for prepaid medical care was first used by 

the Buffalo, New York Plan in 1939. (Doc. # 1353-7 at 25-26, 63-64). Other Plans began using 

these same symbols as well. (Docs. # 1350-35 at 2; 1349 at 11; 1431 at 15; 1435 at 12).

In 1938, the American Hospital Association (“AHA”) developed a program to grant 

membership to local prepaid hospital plans. Forty plans were approved for membership, including 

BCBS-AL’s predecessor, Hospital Service Corporation of Alabama (“HSC-AL”). (Compare Doc. 

# 2728 at ¶ 12; Doc. # 2747 at ¶ 12). By 1938, the American Medical Association (“AMA”) 

“endorsed [the] principle of ‘Medical service plans’” “and set forth guiding principles” for such 

plans. (Doc. # 1353-5 at 36). 

HSC-AL enrolled its first subscribers in 1936, and began using the Blue Cross mark in

1939 and the Blue Shield mark in 1947. This was after the AMA and the AHA had set their 

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respective standards for use of the marks. (Doc. # 2747 at 7). After 1939, HSC-AL continuously 

used the Blue Cross mark. (Doc. # 2735; Doc. # 1353-13 at 12-3, 7-19). By 1949, BCBS-AL was 

advertising its “medical-surgical” plan as the “Blue Cross – Blue Shield” plan, and it used both 

the Blue Cross and Blue Shield marks together in commerce. (Doc. # 2735; Doc. # 1353-13 at 54-

56). So, by 1949, BCBS-AL was using both marks on a state-wide, exclusive basis. (Doc. # 2735; 

Doc. # 1353-13 at 54-56). Other Blue Plans similarly used the Blue Cross and/or Blue Shield 

marks in the 1930s and 1940s, but not always in an exclusive manner or on a state-wide basis. 

(Doc. # 2747 at 7). Some Blues registered their marks locally. (Doc. # 2747 at 8).

In 1946, Congress enacted the Lanham Act, which provided national protection for 

trademarks by virtue of federal registration. 15 U. S. C. §1051(a)(1). Given this change in law, the 

Blue Plans and the national organizations discussed how best to protect their marks. (Doc. # 2735 

-5 at 4; Doc. # 2735 at 6; Doc. # 2735-8). In 1947 and 1948, the national organizations applied for 

federal registration of their Blue Cross and Blue Shield marks (collectively, the “Blue Marks”). 

(Docs. # 1353-28; 1353-29; 1353-31; 1353-47; 1353-48 at 2; 2735-7 at 4; 2735-4 at 9). 

Federal trademark registrations were issued to the national organizations in 1952. (Docs. #

1350-36; 1350-37; 1350-38; 1350-40; 1350-41; 1350-42; 1353-30). After the federal trademarks 

were issued, the local Plans entered into written license agreements with the national organizations.

(See, e.g., Doc. # 1353-48; Doc. # 1353-50). The 1952 and 1954 license agreements confirmed 

that the Plans had centralized local rights to the Marks in the national organizations and that the 

national organizations, in turn, licensed the federal Blue Mark(s) back to each Plan. (Doc. # 1353-

48 at 2-4; Doc. # 1353-50 at 2-4). In areas where a single Blue Cross Plan had historically operated, 

such use was deemed “exclusive”; but, in areas where multiple Plans had historically operated, the 

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license agreements reflected that reality with respect to those particular Plans. (See, e.g., Doc. #

1353-50 at 4).

In 1972, AHA transferred ownership of the Blue Cross Marks to the Blue Cross 

Association (Doc. # 1353-57), and the Association issued new license agreements to the Plans. 

(Doc. # 1353-100 at 2). In 1982, the Blue Cross Association merged with the Blue Shield 

Association (formerly BSMCP) to create the Blue Cross and Blue Shield Association. (Doc. # 

1353-10 at 33:10-24; Doc. # 1349-43 at 4-6; Doc. # 1349-27 at 44). In 1991, the Association 

reissued License Agreements to the Plans. (See, e.g., Doc. # 1349-11 at 3; Doc. # 1349-12 at 3). 

In 2005, the NBE Rule was adopted. It required a Blue Plan to derive at least sixty-six and 

two-thirds percent of its national health insurance revenue from its Blue brands. In re Blue Cross 

Blue Shield Antitrust Litig., 308 F. Supp. 3d 1241, 1256 (N.D. Ala. 2018) (citing Doc. # 1349-16 

at 7). Thus, under NBE, any health revenue a Blue Plan generated from services offered under any 

non–Blue brand was limited in relation to its Blue branded health revenue. Id. (citing Doc. # 1432 

at 20–21). NBE did not specifically address contracting with Providers, nor did it place any limits 

on contracting with Providers under non-Blue brands. 

II. Standard of Review

Summary judgment is warranted if, viewing the facts in the light most favorable to the 

nonmoving party, no material fact is subject to a genuine dispute. Matsushita Elec. Indus. Co. v. 

Zenith Radio Corp., 475 U.S. 574, 585-87 (1986). The appropriate standard for evaluating conduct 

challenged under the Sherman Act—rule of reason or per se—is a question of law for the court to 

decide. Food Lion, LLC v. Dean Foods Co., (In re Milk Antitrust Litig.), 739 F.3d 262, 271 (6th 

Cir. 2014) (“The district court’s decision to use the rule of reason is a question of law[], which we 

review de novo.”). While the selection of a mode of analysis (per se or rule of reason) is a question 

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of law, sometimes “underpinning that purely legal decision are numerous factual questions.” In re 

Wholesale Grocery Prods. Antitrust Litig., 752 F.3d 728, 733-34 (8th Cir. 2014).

III. Analysis

As the Supreme Court recently explained,

Section 1 of the Sherman Act prohibits “[e]very contract, combination in the form 

of trust or otherwise, or conspiracy, in restraint of trade or commerce among the 

several States.” 15 U.S.C. § 1. This Court has long recognized that, “[i]n view of 

the common law and the law in this country” when the Sherman Act was passed, 

the phrase “restraint of trade” is best read to mean “undue restraint.” Standard Oil 

Co. of N.J. v. United States, 221 U.S. 1, 59–60, 31 S.Ct. 502, 55 L.Ed. 619 (1911). 

This Court’s precedents have thus understood § 1 “to outlaw only unreasonable

restraints.” State Oil Co. v. Khan, 522 U.S. 3, 10, 118 S.Ct. 275, 139 L.Ed.2d 199 

(1997) (emphasis added).

Ohio v. Am. Express Co., 138 S. Ct. 2274, 2283 (2018). 

A restraint may be deemed unreasonable “either because it fits within a class of restraints 

that has been held to be ‘per se’ unreasonable, or because it violates what has come to be known 

as the ‘Rule of Reason.’” FTC v. Indiana Fed’n of Dentists, 476 U.S. 447, 457–58 (1986) (quoting 

Chicago Bd. of Trade v. United States, 246 U.S. 231, 238 (1918)). “Determining whether a restraint 

is undue for purposes of the Sherman Act ‘presumptively’ calls for what we have described as a 

‘rule of reason analysis.’” Nat’l Collegiate Athletic Ass’n v. Alston, 141 S. Ct. 2141, 2151 (2021) 

(quoting Texaco Inc. v. Dagher, 547 U.S. 1, 5 (2006)).

A. There is Daylight Between the Current Facts of this Case and Topco and Sealy

Defendants argue that ESAs alone are not per se unlawful and that, with the elimination of 

NBE, Providers’ Section 1 claims should be subject to the Rule of Reason. Providers maintain that 

there is “no daylight between this case and Topco and Sealy,” and that those cases dictate a finding 

that ESAs alone are per se unlawful. (Doc. # 2747 at 19). The court disagrees. 

In United States v. Sealy, Inc., the licensor, Sealy, agreed to allot exclusive territories to its 

licensee-members, a group of mattress manufacturers. 388 U.S. 350, 352 (1967). Sealy also, 

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however, set the prices its members could charge for their products. Sealy, 388 U.S. at 354-55. 

Therefore, as the Supreme Court noted, “[i]n the present case, we are [] faced with an ‘aggregation 

of trade restraints.’” Id. at 354. In Sealy, the “territorial exclusivity[’s] connection with the 

unlawful price-fixing [was] enough to require that it be condemned as an unlawful restraint[].” Id.

at 356-57. Under these facts, the Supreme Court held that “territorial limitations [that] are part of 

‘an aggregation of trade restraints’ [] are unlawful under § 1 of the Sherman Act without the 

necessity for an inquiry in each particular case as to their business or economic justification, their 

impact in the marketplace, or their reasonableness.” Id. at 357-58. The court in Sealy, like this 

court previously, did not evaluate the issue of a horizontal market allocation alone. Rather, the 

Sealy Court was confronted with an aggregation of trade restraints. So, the posture of the claims 

in Sealy was similar to what this court faced when it issued its 2018 ruling. But, now that the NBE 

rule has been eliminated, this court is not dealing with the same aggregation of restraints, at least 

for purposes of assessing (1) injunctive relief and (2) damages beginning in April 2021.

In United States v. Topco Associates, Inc., a group of small and medium-sized supermarket 

chains associated together to sell private-label goods under Topco’s brand names. 405 U.S. 596,

598, 601-02 (1972). Membership in the association had to be “approved by the board of directors, 

and thereafter by an affirmative vote of 75% of the association’s members.” Topco, 405 U.S. at

602. “[T]he procedure for approval provide[d], in essence, that members have a veto of sorts over 

actual or potential competition in the territorial areas in which they are concerned.” Id. Nothing in 

Topco, however, indicates that any of the member chains had any right to use the Topco brand 

prior to becoming a member of the association. Id. (“Following approval, each new member signs 

an agreement with Topco designating the territory in which that member may sell Topco-brand 

products.” (emphasis added)). The fact that, here, the Blue Plans had at least some sort of

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preexisting common law trademark rights to the Blue Marks before the License Agreements 

memorialized or settled those rights is a distinction with a difference. Therefore, Topco is also 

distinguishable on these grounds. 

Of course, “the mere fact that an agreement implicates intellectual property rights does not 

“immunize [the] agreement from antitrust attack.” 1-800 Contacts, Inc. v. Fed. Trade Comm’n, 1 

F.4th 102, 113 (2d Cir. 2021) (quoting FTC v. Actavis, 570 U.S. 136, 147 (2013) and citing In re 

Indep. Serv. Orgs. Antitrust Litig., 203 F.3d 1322, 1325 (Fed. Cir. 2000) (“Intellectual property 

rights do not confer a privilege to violate the antitrust laws.”)). However, “[a]greements to protect 

trademarks [] should not immediately be assumed to be anticompetitive – in fact, Clorox tells us 

instead to presume they are procompetitive.” 1-800 Contacts, 1 F.4th at 116 (citing Clorox Co. v. 

Sterling Winthrop, Inc., 117 F.3d 50, 55-56 (2d Cir. 1997) (“Such agreements are common, and 

favored, under the law.”)).

In 2018, this court discounted Defendants’ trademark justification for ESAs when it 

considered the aggregation of ESAs and NBE because “there [was] nothing in the Rule 56 record 

which indicate[d] that there [was] any valid connection between trademark rights and the National 

Best Efforts rule.” In re Blue Cross Blue Shield Antitrust Litig., 308 F. Supp. 3d at 1272. Where 

restraints are derived from trademark agreements, however, they “could plausibly be thought to 

have a net procompetitive effect[]. 1-800 Contacts, 1 F.4th at 116. (“Crucially, the restraints at 

issue here could plausibly be thought to have a net procompetitive effect because they are derived 

from trademark settlement agreements.”). In light of 1-800 Contacts, and the elimination of the 

NBE rule, Defendants’ argument that the ESAs arose from common law trademark rights warrants 

a closer look. “[E]ven though trademark agreements inherently prevent competitors ‘from 

competing as effectively as [they] otherwise might’ [] ‘it is difficult to show that an unfavorable 

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trademark agreement creates antitrust concerns.’” 1-800 Contacts, 1 F.4th at 119 (citing Clorox, 

117 F.3d at 55, 57). 

In VMG Enterprises, Inc. v. F. Quesada & Franco, Inc., cited by Defendants, two 

manufacturers of baby diapers (VMG and non-party UCI) separately acquired the right to use the 

mark “BABY’S CHOICE” in their own geographies. 788 F. Supp. 648, 651, 654 (D.P.R. 1992). 

Following competing filings to register their respective marks, VMG and UCI entered into a 

concurrent use agreement in which they agreed that each manufacturer could use the mark in its 

exclusive territorial region, which for VMG included Puerto Rico. VMG, 788 F. Supp. at 651-52, 

657. VMG then sued the defendant, who was selling baby diapers in Puerto Rico under the name 

“BABY’S CHOICE.” Id. at 650. The defendant filed a counterclaim asserting the “theory [that]

VMG’s and UCI’s concurrent use registrations are based on agreements which divide trademark 

territories” and therefore violate antitrust laws. Id. at 657. The court disagreed. It reasoned that 

“the territorial division in question is legitimate under both common law and by statute, as intended 

to promote the underlying principles of the trademark laws in general and the Lanham Act,” 

including the “protection of a party’s investment in developing the goodwill of its products.” Id. 

(citing In re Beatrice Foods Co., 429 F.2d 466, 472, n.10 (3d. Cir. 1970) (discussing the legislative 

history of the Lanham Act)). Moreover, the court held, “[t]he concurrent use agreement, and the 

registration that followed it, did not ‘create’ a trademark territorial division for the BABY’S 

CHOICE mark between VMG and UCI; it merely recognized it.” Id. “[T]he division was already 

a reality as a matter of trademark law.” Id. 

Something similar can be said about the Blue Marks and the ESAs in this case. Prior to the 

introduction of the License Agreements with the Association and with its predecessors, the Blue 

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Plans had been using the Blue Marks and had already acquired at least some common law 

trademark rights in the Marks. 

Providers dispute that the Blue Plans had any preexisting common law trademark rights to 

the Blue Marks. (Doc. # 2747 at 15-16). Providers argue that any common law rights to the Marks 

were abandoned through “naked licensing,” or, alternatively, that the Plans were mere licensees of 

national organizations. However, as they admit, “1954 Blue Cross [license] agreement and the 

1952 Blue Shield [license] agreement [] describe pre-existing rights in the Blue Cross and Blue 

Shield marks.” (Doc. # 2747 at 8, ¶ 21). Those agreements came about to provide clarity on the 

rights to the Blue Cross and Blue Shield marks following the passage of the Lanham Act. (Doc. # 

2735 -5 at 4; Doc. # 2735 at 6; Doc. # 2735-8). And, agreements settling trademark rights “are not 

so obviously anticompetitive to consumers that someone with only a basic understanding of 

economics would immediately recognize them to be so.” 1-800 Contacts, Inc. 1 F.4th at 117. 

Furthermore, such a “settlement” of trademark rights need not arise from litigation. In 1-800 

Contacts, one of the trademark agreements at issue arose out of a business arrangement between 

1-800 Contacts and a lens supplier, Luxottica—not any direct threat of litigation. 2021 WL 

2385274, at *3.

In any event, the court need not define the exact nature or extent of the Blue Plans’ common 

law rights in the marks. According to Clorox, “[w]e begin with the fact that [Providers] challenge 

a trademark agreement [which] are common, and favored, under the law.” Clorox, 117 F.3d at 55

(citing 2 J. Thomas McCarthy, McCarthy on Trademarks and Unfair Competition § 18:25 (4th 

ed.1996)). Importantly, ESAs “do[] no more than regulate how the [Blue Mark] may be used; 

[they] do[] not in any way restrict [a Blue Plan] from producing and selling products that compete 

directly with the [Blue] brand, so long as they are marketed under a brand name other than [a Blue 

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Mark].” Clorox, 117 F.3d at 57. ESAs, and the License Agreements effecting them, “[do] not 

restrict a competitor’s ability to market products under names other than the one precluded by the 

agreement,” i.e., the Blue Marks. Id. (citing California Packing Corp. v. Sun-Maid Raisin 

Growers, 165 F. Supp. 245 251 (S.D. Cal. 1958), aff’d, 273 F.2d 282 (9th Cir. 1959)). That is, the 

ESAs do not limit a Blue Plan’s ability to operate under non-Blue brands. It was the now-defunct 

NBE rule that operated to preclude that. Without NBE, even under the Blues’ ESAs, the Plans are 

free to enter into any market under a non-Blue brand. The only market in which the Blue Plans’

ability to compete under a non-Blue brand is limited is the market to which their License 

Agreement applies, and in that market they are already naturally disincentivized to operate a nonBlue business there because they would be competing against themselves. 

Because (1) courts “presumptively” apply a “rule of reason analysis” NCAA, 141 S. Ct. at

2151, (2) trademark agreements are “common, and favored, under the law,” Clorox, 117 F.3d at

55, and (3) trademark agreements do not immediately appear “obviously anticompetitive,” 1-800 

Contacts, Inc. 1 F.4th at 117, the court concludes that the appropriate standard of review under 

which the court will evaluate ESAs alone is the Rule of Reason. The court emphasizes that this 

holding is applicable only to the period of time following the elimination of the NBE rule in April 

2021. 

B. NBE Is Relevant to Providers’ Claims

Defendants argue that Providers’ Section 1 claims should be evaluated under the Rule of 

Reason for the entire class period, rather than just following the elimination the NBE rule, because 

NBE was a Subscriber-facing rule that has nothing to do with Provider claims. (Doc. # 2728 at 34-

36 (“NBE was a subscriber-facing rule that governed solely the percentage of subscriber-related

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revenue that a Plan may earn from non-Blue-branded sales on a nationwide basis.”) (emphasis in 

original)). The court disagrees.

Providers respond that they have asked for relief in relation to NBE from the beginning of 

this case. Indeed, in their Consolidated Fourth Amended Complaint, Providers summarized the 

basis for their Market Allocation Conspiracy claims as follows:

In furtherance of the Market Allocation Conspiracy, Defendants agreed that each 

Defendant would be allocated a defined Service Area and further agreed that each 

Defendant’s ability to operate and to generate revenue outside its geographic 

Service Area would be severely restricted.

(Doc. # 1083 at ¶ 5) (emphasis added). They further alleged that:

The non-Blue revenue restriction agreement, which the Blues call “best efforts 

rules” to hide the obvious anti-competitive effects of this agreement also reinforces

the other agreements and prevents the Defendants from engaging in meaningful 

competition in any manner.

(Id. at ¶ 15). Providers also alleged that the effect of NBE is to “put[] an artificial limit on 

competition” and “reduce[] the incentive for the Blues to develop business out of their Service 

Areas because they know that the potential for that business is limited.” (Id. at ¶ 365). In their brief 

in response to Defendants’ July 2017 Motion for Summary Judgment, Providers included a section 

headed, “[t]he “Best Efforts” Rules Are Unlawful Limitations on Output.” (Doc. # 1431 at 61). 

They argued that “the Blues’ limits on non-Blue revenue [NBE] restrain potential competition.” 

(Id. at 32). 

Defendants are wrong that NBE is only relevant to the Subscriber case. Providers have also 

alleged that NBE is part of their Market Allocation Conspiracy claim. And restricting the 

development of non-Blue insurance options for Subscribers could also have the effect of reducing 

the options available to Providers to contract with non-Blue health insurers. Therefore, Providers’ 

Section 1 Market Allocation Conspiracy claims involving the aggregation of ESAs and NBE will 

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remain subject to the court’s 2018 standard of review decision for the period of time before NBE 

was eliminated.

IV. Conclusion

For all of the foregoing reasons, Defendants’ Motion Regarding the Antitrust Standard of 

Review Applicable to Provider Plaintiffs’ Section 1 Claims (Doc. # 2722) is GRANTED IN 

PART AND DENIED IN PART.

The Motion is GRANTED to the extent that the court concludes that ESAs, viewed alone

(i.e., divorced from NBE), “should not immediately be assumed to be anticompetitive,” 1-800 

Contacts, 1 F.4th at 116, and thus are not “naked restraint[s] of trade with no purpose except 

stifling competition.” Levine v. Cent. Fla. Med. Affiliates, Inc., 72 F.3d 1538, 1550 (11th Cir. 

1996). Therefore, for the period of time following the elimination of the NBE rule (after April 

2021), the court concludes that it must apply the rule of reason analysis to Providers’ Market 

Allocation Conspiracy claims. 

In all other respects, the Motion is DENIED. 

DONE and ORDERED this August 9, 2022.

_________________________________

R. DAVID PROCTOR

UNITED STATES DISTRICT JUDGE

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