Major pharmacy chain reaches multi-million settlement after years of questioned practices

CVS Pharmacy has agreed to a $37.76 million settlement with federal prosecutors following an investigation into its insulin dispensing practices. The lawsuit, spanning from 2010 to 2020, alleged that CVS repeatedly dispensed more insulin to patients than prescribed and improperly billed government health programs – including Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefits Program – for excess refills. Prosecutors found that CVS often sought reimbursement for refills issued before patients needed them and inaccurately reported the duration of each refill.

U.S. Attorney Jay Clayton stated that CVS bypassed safeguards designed to ensure accurate refill timelines and medication tracking, leading to ineligible reimbursements. The pharmacy chain sometimes claimed the maximum allowable “days-of-supply” even when dispensing exceeded that limit, hindering detection of early refills and potentially leading to excess insulin accumulation for patients.

Of the settlement, $24.4 million will be allocated to the federal government, with the remaining funds distributed to participating states. CVS did not contest the allegations outlined in the settlement, which was approved by U.S. District Judge John G. Koeltl.

(Source：Cleveland)