Four state attorneys general sued CVS Health and its pharmacies for allegedly submitting “false and fraudulent” claims to state Medicaid programs.
Connecticut, Indiana, Oklahoma and Massachusetts claim CVS has not submitted usual and customary prices available to other payers on prescription drug claims to Medicaid since 2016. This resulted in state Medicaid programs overpaying CVS compared to other health plans.
CVS ran discount card programs and transactions through MedImpact company ScriptSave, which served as a third-party administrator and vendor, per the lawsuit.
“CVS worked strategically with ScriptSave to set pricing, and thus CVS (and not ScriptSave) was the party offering these discounts to the general public,” the lawsuit said.
CVS flatly denied the lawsuit’s credibility in a statement to Fierce Healthcare and said the company has already prevailed in similar lawsuits.
”The four states involved in this lawsuit have never issued guidance to pharmacies contending that third-party discount card prices constitute a pharmacy’s Usual & Customary prices,” the spokesperson said.
Blue Cross insurers sued CVS in 2020 for charging lower prices for generic drugs through customer discount programs, while seeking reimbursement from health plans at higher prices for the same medications.
CVS’ cash discount program, Health Savings Pass, was launched in November 2008.
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