CVS Health intentionally prevented certain Medicare beneficiaries from accessing less expensive, generic prescriptions, according to a whistleblower lawsuit from a former senior CVS executive. Documents from the lawsuit were recently unsealed,.

“In doing so, CVS Health has ensured astonishing profits for itself while passing the increased costs onto taxpayers and Part D beneficiaries,” the whistleblower charged in the complaint filed in March and whose contents were published by Stat news on Thursday.

The lawsuit alleges that the fraudulent scheme disproportionately affected elderly patients with end stage renal failure and forced many beneficiaries of the SilverScript Part D program to go without critical treatment because they were unable to access generic versions of necessary drugs at affordable costs. SilverScript offers prescription drug plans for Medicare Part D. CVS Health denied the allegations.

The case shines a harsh spotlight on pharmacy benefit managers, often derided as the middleman in the industry especially given how large PBMs are owned by entities that are also payers that win if patients pay more for drugs. In this case, CVS Caremark, the PBM is owned by CVS Health, which also owns insurer Aetna. After initially declining to do so, the Federal Trade Commission announced earlier this month that the agency is launching an inquiry into PBMs and alleged conflicts of interest.

Medicare Part D helps patients pay for generic and brand name drugs. Unlike other...

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