Walmart to leave CVS Caremark plan

Walmart Inc. is pulling out of one of the nation’s largest drug-benefits networks in a dispute over reimbursements for prescriptions filled at its pharmacies.

CVS Health Corp. said Tuesday that the Bentonville retailer is leaving its CVS Caremark pharmacy-benefit management commercial and Managed Medicaid retail pharmacy networks. However, Walmart will stay in its Medicare Part D drug plan. Walmart’s Sam’s Club division will remain in all the CVS Caremark pharmacy networks.

Walmart is “committed to providing value to our customers across our business, including our pharmacy, but we don’t want to give that value to the middle man,” the retailer said in an emailed statement. “This issue underscores the problems that can arise when a pharmacy benefits manager can exert their unregulated power to direct members on where to fill their scripts, disrupting patients’ health care.”

Pharmacy-benefits managers serve as third-party negotiators dealing with insurance companies, pharmacies and manufacturers to secure lower drug costs for insurers and insurance companies. According to Investopedia. com, “They negotiate with pharmacies and drug manufacturers to secure discounts on drug prices, then pass these discounts along to insurance companies, slightly up-charging the drugs or retaining portions of rebates in order to secure profit.”

Derica Rice, president of CVS Caremark, said in a news release that agreeing to Walmart’s requested reimbursement rates “would ultimately result in higher costs to our clients and consumers. We simply could not agree to their recent demands for an increase in reimbursement.”

CVS Caremark said that while its national pharmacy networks have about 93 million members, less than 5 percent of those affected by Walmart’s withdrawal from the two plans use Walmart exclusively to fill their prescriptions.

To ease the transition, the health care company said in the release that it has asked Walmart to continue filling prescriptions for its members as an in-network pharmacy through April 30. A Walmart spokesman was unable to say whether the retailer has agreed to that request.

Nearly a year ago, Arkansas enacted a comprehensive law requiring pharmacy-benefits managers to be licensed and allowing the state insurance commissioner to ensure their reimbursement rates are fair and reasonable. According to the National Community Pharmacists Association, the law resulted from “an organized effort by Arkansas pharmacists to address drastic cuts in reimbursements.”