Emily Elizabeth Lazarou, et al., v. Am. Bd. of Psychiatry and Neurology, No. 24-1994 (7th Cir.)
The Seventh Circuit affirmed a district court’s dismissal, with prejudice, of psychiatrists’ tying claim alleging that the American Board of Psychiatry and Neurology (“ABPN”) used its monopoly power over specialty certifications to force them to purchase ABPN’s “maintenance of certification” (“MOC”) product. Lazarou v. Am. Bd. of Psychiatry and Neurology, 2025 WL 3022661, at *1 (7th Cir. 2025). The plaintiffs’ theory of the case required that psychiatrists and neurologists view ABPN’s product as a viable alternative to fulfilling their continuing medical education (“CME”) requirements. Id. The Seventh Circuit affirmed the district court’s finding that ABPN’s MOC products were not plausibly reasonably interchangeable with the CME products. Id.
For doctors to maintain their license, most states require completion of a certain number of CME hours. The Lazarou complaint focused on two categories of CME products: Category 1 “direct credits” and Category 2 credits earned by purchasing CME self-assessment products. Id. Category 1 “direct credits” are earned by either purchasing products from any accredited vendor or completing educational activities and applying to the American Medical Association (“AMA”) for “direct credit.” Id.
Licensed doctors may also purchase certifications from medical specialty boards such as the ABPN. Id. According to the complaint, while board certification is not legally required, almost all medical organizations require board certification for employment, hospital privileges, and coverage by health insurance plans. Id. To maintain their specialty certification, doctors must purchase ABPN’s MOC product annually for a $175 fee or risk revocation. Id. Doctors can only secure MOC from the ABPN. Id.
ABPN’s MOC has two main components: Activity Requirements and an Assessment Requirement. Id. at *2. As part of the Activity Requirements, every three years doctors must obtain 90 CME credits and complete one Improvement in Medical Practice (referred to as “PIP”) activity. Id. Of the 90 CME credits, 66 must be CME Category 1 and 24 must be CME Category 2 self-assessment credits. Id. For the MOC Assessment Requirement, doctors can either complete an Article-Based Pathway every three years or pass a Recertification Exam every ten years. Id. When a doctor successfully completes an Article-Based Pathway, ABPN waives 16 out of the 24 CME Category 2 self-assessment credits. Id. ABPN similarly waives 8 out of the 24 CME Category 2 self-assessment credits for doctors who take the Recertification Examination. Id. Plaintiffs filed this class action claiming that ABPN’s tying of its certifications and MOC violated Section 1 of the Sherman Act. Id.
The Seventh Circuit found that the Plaintiffs did not plausibly allege that the MOC was a substitute for CME products. Id. at *4. The Court used its past decision in Siva v. Am. Bd. of Radiology, 38 F.4th 569 (7th Cir. 2022) in concluding that Plaintiffs did not plausibly allege that a reasonable consumer would see the ABPN’s MOC products as a true competitor in the CME market. Lazarou, 2025 WL 3022661,at *4. In Siva, the Seventh Circuit found that a radiology board’s MOC was not a substitute for the rest of the market’s CME. Siva, 38 F.4th at 580-81. In that case, radiologists had to: (1) obtain certain CME credits from a third-party vendor every year; (2) complete an examination component consisting of weekly tests; and (3) fulfill a series of practice improvement projects. Id. at 579. The Seventh Circuit held that the first requirement was not a likely substitute for CME because it would be redundant to purchase MOC to then be forced to buy CME elsewhere. Id. Moreover, CME provided educational content, but MOC’s first requirement did not. Id. As to the second and third requirements, these did involve educational content. Id. at 580. However, the Court found there was “no reason to think radiologists would view these tests and activities as viable [CME] products” since they could not “earn CME credits by completing [them].” Id.
Plaintiffs argued their complaint addressed Siva’s shortcomings by alleging that (1) ABPN’s MOC contains educational content and (2) doctors use ABPN’s MOC to meet state CME licensure requirements partially or in full. Lazarou, 2025 WL 3022661,at *4. On the second point, Plaintiffs presented two theories. Id. First, Plaintiffs alleged that many states accept MOC participation as full satisfaction of CME requirements, without the need to obtain any additional Category 1 credits, referred to as the “full satisfaction theory.” Id. Second, Plaintiffs allege that doctors who complete the Recertification Examination may apply to the AMA for direct CME credit and use those credits towards state licensing requirements, referring to this as the “direct credit theory.” Id. The Court rejected all of Plaintiffs’ arguments. Id.
The Court rejected Plaintiffs’ first point because it found that only the MOC Assessment Requirements can lead to direct CME credit and are therefore equivalent to other CME products. Id. MOC’s Activity Requirements are different and, as the Court found, not CME-equivalent. Id.
The Court rejected the full satisfaction theory because it did not account for the MOC product’s requirements in their entirety. Id. Specifically, the use of ABPN’s MOC did not account for the required PIP activity and the Assessment Requirement. Id. at *5. When taken into account, doctors signing up to buy fewer CME credits to satisfy their state licensure CME obligations would also have to spend considerable time, money, and effort completing a PIP, taking 30 article-based exams every three years or a Recertification Examination every ten years—all in addition to paying a $175 fee for MOC. Id. Thus, the Court found that ABPN’s MOC could not be inferred to be a viable alternative to CME products. Id.
Finally, the Court rejected Plaintiffs’ direct credit theory. Id. Plaintiffs argued that psychiatrists and neurologists can apply ABPN’s Assessment products to satisfy state CME requirements, which was the case for one of the named Plaintiffs. Id. The Court found the theory implausible because it would require doctors to invest more time, money, and effort in the long run due to the longer list of requirements associated with the ABPN’s MOC. Id.
The Seventh Circuit also rejected Plaintiffs’ argument that their dismissal should not have been with prejudice. Id. at *6. The Court found that Plaintiffs had multiple opportunities to amend their complaint. Id. Thus, the Seventh Circuit found that the district court had not abused its discretion when it denied Plaintiffs’ motion for leave to amend. Id.
Overall, in Lazarou, the majority solidified its finding in Siva that specialty board MOC products are not reasonably interchangeable with CME products doctors purchase to maintain their license. The Court held that it would be implausible to hold that doctors could purchase MOC products as a way to satisfy CME requirements because it would result in considerably more work for the doctors. Thus, the district court finding was affirmed, and the case was dismissed with prejudice. Id. at *6.
Judge Maldonado wrote the dissent for the opinion, stating her concerns about the continuously heightening pleading standard for antitrust claims in the circuit. Id. She reviewed the evolution of pleading standards for antitrust claims and argued that Plaintiffs’ 51-page complaint was replete with details such that dismissal was unwarranted. Id. at *6-7. She argued that, by affirming the dismissal, the Court was “changing the goal posts in the middle of the game.” Id. at *7.
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This article was originally published in the California Lawyers Association E-Briefs, News and Notes: January 2026
