It’s been a rocky road for CVS of late. In July, CVS was assessed a multi-million $ fine in an arbitration case filed by a small specialty pharmacy (see our report on 7/14/2022) and now, CVS is facing a major anti-trust suit by the State if New York relating to how it self-directed prescriptions for Part D members.
Here’s the skinny…..
On July 28, 2022, the Attorney General of the State of New York (NYOAG) brought an antitrust suit against CVS Health in Manhattan state court. The NYOAG accused CVS of violating the Donnelly Act, New York’s state antitrust law, by illegally tying access to contract pharmacy services at CVS retail and specialty pharmacies to the use of a third-party administrator (TPA) called Wellpartner, a company CVS acquired in 2017. The business segment in question is the CVS Silverscripts Part D membership and also the the role played by CVS Caremark, its PBM.
The NYOAG requests civil monetary penalties and to enjoin CVS’s anticompetitive conduct and require CVS to notify New York 340B hospitals that exclusive use of Wellpartner is no longer required. More surprisingly, the NYOAG also seeks “equitable relief which could include an injunction and an order of divestiture” of the Wellpartner business.”
Oh what a tangled web…….
Whistleblower suit: CVS prevented Part D members from accessing generics
A lawsuit against CVS Health comes as policymakers are turning up the heat on pharmacy benefit managers.
A newly unsealed whistleblower suit claims that multiple CVS Health subsidiaries coordinated to prevent members from accessing generic drugs in a bid to boost the bottom line.
The suit was filed by Alexandra Miller, who worked at CVS for nearly two decades before leaving the company three years ago. When she reported the behavior to a superior, she was told that the company had decided the benefits of the alleged scheme outweighed the likelihood of being caught.
Miller claims that CVS’ SilverScripts Part D subsidiary as well as its Caremark pharmacy benefit manager and retail pharmacies worked together to prevent access to generics, which allowed it to pocket higher rebates because members were pushed to buy branded medications rather than lower-cost options.
Members were also often kept in the dark about potential authorized generic medications or identical drugs that are produced by the same manufacturer but offered at a lower cost.
The company violated Medicare regulations by………….