CVS’ pharmacy benefit unit sued for false claims

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.