CVS’ phar­macy ben­e­fit unit sued for false claims

Modern Healthcare - - Late News - —Tara Ban­now

A re­cently un­sealed False Claims Act law­suit against CVS Health claims the com­pany, through its phar­macy ben­e­fits man­ager unit, il­le­gally billed Medi­care for prices higher than it paid phar­ma­cies.

Sarah Behnke, a se­nior ac­tu­ary with Aetna, filed the law­suit in 2014 al­leg­ing that CVS Care­mark was get­ting bet­ter prices on drugs with its phar­ma­cies, but was not pass­ing those sav­ings to Medi­care Part D. The law­suit was un­sealed af­ter the federal gov­ern­ment de­clined to in­ter­vene in the case on April 2.

Aetna re­quested that CVS Care­mark rene­go­ti­ate with its phar­ma­cies af­ter Behnke no­ticed Aetna did not seem to be ob­tain­ing com­pet­i­tive prices for its Medi­care Part D plans. Dur­ing those dis­cus­sions, the law­suit al­leges CVS Care­mark ad­mit­ted it had bet­ter prices with phar­ma­cies, but that it did not pass those through to Aetna’s Part D plan.

The suit al­leges that those bet­ter prices were not re­ported to the CMS, de­spite a 2010 man­date to do so. Behnke es­ti­mated in her com­plaint that CVS Care­mark hid $1.5 bil­lion in 2014 alone.

CVS Health spokesman Mike DeAn­ge­lis wrote in an email that the claims are with­out merit and the com­pany plans to vig­or­ously de­fend it­self.

CVS Health is in the midst of a pro­posed $69 bil­lion merger with Aetna, which their re­spec­tive share­hold­ers signed off on in March.

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