In Brief

• CVS agreed to pay $36.5 million to resolve allegations it improperly billed government health care programs for insulin pens.
• Minnesota will receive more than $850,000, including $400,000 in restitution for its Medical Assistance Program.
• The allegations involved claims submitted to Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefits Program between 2010 and 2020.
• The settlement resolves claims under the False Claims Act that CVS dispensed insulin quantities exceeding approved supply limits and submitted inaccurate reimbursement information.

CVS Pharmacy Inc. has agreed to a $36.5 million national settlement over allegations it overbilled government health care programs for insulin pens. Minnesota Attorney General Keith Ellison has announced that the state will receive more than $850,000 from the settlement.

Insulin pens are often distributed in five-pen cartons, with each pen containing 300 units (3 milliliters) of insulin solution. When pharmacies submit reimbursement claims to government health care programs and other health plans, they must accurately report the quantity dispensed and the days-of-supply, which reflects how long the medication should last based on the prescribed daily dose. Health care plans and pharmacy benefit managers use this information to enforce supply limits, review claims, and prevent reimbursement for prescriptions that are dispensed too early or exceed approved days-of-supply limits.

Ellison was part of a...

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