State of Hawaii Wins $700 Million Settlement After Plavix Makers Concealed Genetic Risk for Twelve Years

In February 2021, a Honolulu circuit court judge entered a $834 million bench verdict against Bristol-Myers Squibb and Sanofi, finding both companies had violated Hawaii's consumer protection laws by concealing a critical limitation of their blockbuster blood thinner Plavix. That ruling set off a chain of proceedings that would end, four years later, in a $700 million settlement.

Plavix (clopidogrel) was marketed as a cornerstone therapy for preventing strokes and heart attacks. The drug requires activation by a liver enzyme, CYP2C19, and roughly 30 percent of patients carry a genetic variant that limits or eliminates that activation. That rate is meaningfully higher among people of East Asian and Pacific Islander descent, groups that make up a substantial share of Hawaii's population. Between December 1998 and March 2010, roughly 834,000 Plavix prescriptions were filled in Hawaii. The state argued that many of those patients were paying for a drug that provided no more protection than aspirin.

Trial evidence, drawn from more than 12.5 million internal company documents, showed the manufacturers understood the metabolization problem at the drug's 1998 launch but kept the limitation off the warning label for twelve years. The FDA finally required a black-box warning in 2010. Hawaii, under then-Attorney General David Louie, filed suit in 2014 after the state's Medicaid program had funded those prescriptions.

L. Richard Fried, Jr. and Patrick F. McTernan of Cronin, Fried, Sekiya, Kekina and Fairbanks, working alongside the Baron and Budd firm out of Dallas, represented the State. In February 2021, Judge Dean Ochiai found the companies had "knowingly placed Plavix patients at grave risk of serious injury or death in order to substantially increase their profits" and entered a civil penalty of $834 million. The team was named a finalist for the 2022 Public Justice Trial Lawyer of the Year award.

Bristol-Myers Squibb and Sanofi appealed, and in 2023 the Hawaii Supreme Court vacated the penalty and ordered a new trial. A retrial followed, and in May 2024 the court returned a larger figure: $916 million, comprising $834 million for deceptive practices and $82 million for unfair practices. After a second appeal, the parties reached a final settlement in May 2025 at $700 million, split equally between the two defendants. Governor Josh Green stated the state expected to receive the full amount by June 9, 2025, with proceeds directed to Hawaii's general fund for health and social programs.