Attorney General sues CVS for allegedly failing to provide discounts to MassHealth members
Photo | State House News Service
Massachusetts Attorney General Andrea Campbell
Attorney General Andrea Campbell and a few of her peers sued CVS on Wednesday, alleging the pharmacy giant for years failed to provide Medicaid members with access to the same discount as cash-paying customers.
Campbell and attorneys general in Connecticut, Indiana and Oklahoma jointly filed a civil action after a whistleblower complaint in Washington, D.C., prompting the company to "strongly dispute" the allegations.
Prosecutors allege that since at least 2016, CVS failed to submit required "usual and customary" prices on prescription drug claims to Medicaid. The complaint alleged that through a discount card program with ScriptSave, CVS customers who paid in cash received discounts for some drugs that were not then extended to MassHealth and other Medicaid recipients.
As a result, attorneys general said Medicaid payers often faced higher prices for drugs at CVS than non-Medicaid payers did.
Massachusetts regulations require pharmacies to charge MassHealth the lowest price they would charge any other customer, according to Campbell's office.
"When pharmacies offer discounted drug pricing to its customers, they must also charge MassHealth that same low price," Campbell said in a statement. "At a time when costs are sky-high, our taxpayers should not have to foot the bill for pharmacies' inaccurate price reporting."
CVS spokesperson Amy Thibault said the company "strongly dispute[s] the allegations that our prices to Medicaid programs were inaccurate or inflated."
"We've always been transparent with Medicaid programs concerning the prices we were submitting. 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," Thibault said in a statement. "For the last several years, many pharmacies, including CVS Pharmacy, have been named as defendants in other U&C lawsuits accusing the pharmacies of having submitted inflated U&C prices. In the cases involving CVS, we've prevailed many times, including by dismissal of the plaintiff's allegations by the Court and by verdicts from juries or final awards by arbitrators."
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