The case against Caremark stretches back more than a decade. In 2014, a whistleblower accused the PBM of knowingly misrepresenting the cost of drugs at Walgreens and Rite Aid stores, causing Medicare prescription drug plans, including Aetna, to inflate how much their beneficiaries were paying. As a result, those plans overcharged Medicare for the drugs for years.
The whistleblower, Sarah Behnke, is a former head actuary for Medicare Part D at Aetna, which CVS bought in 2018.
Actual damages due to Caremark’s scheme reached $95 million. But Goldberg elected to triple the amount as allowed under the False Claims Act, which lets whistleblowers bring complaints on the government’s behalf and share in potential damages.
Caremark argued tripling damages was excessive. Goldberg allowed that the fine is significant, but said it was fair based on Caremark’s actions.
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