NEW YORK — CVS Health has agreed to pay $37.76 million to resolve allegations that it over-dispensed insulin pens and improperly billed federal health care programs. The settlement, announced by the Department of Justice, covers a 10-year period from 2010 to 2020 and addresses violations of the False Claims Act involving Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefits Program.
Federal authorities alleged CVS pharmacies repeatedly refilled prescriptions prematurely, dispensed more insulin than prescribed, and under-reported days-of-supply, which prevented pharmacy benefit managers from detecting early refills. These practices led to excess insulin stockpiling by patients, creating waste and potential safety risks.
Under the agreement approved by U.S. District Judge John G. Koeltl, CVS will pay $24.4 million to the United States and the remainder to various states. CVS admitted responsibility for certain conduct outlined in the government’s complaint.
In a statement, a CVS Health spokesperson said, "While we do everything we can to ensure patients can access the medications they need, insulin pen billing has long been a challenge for pharmacies. Factors like FDA labeling changes, no single pen packaging options, insulin dosing variability, and varying payor supply limits and instructions have made billing for these medications incredibly complex. In recent years, the evolution of PBM and payor practices to account for insulin pen packaging and other technological enhancements have helped alleviate some of these challenges. With this settlement, we’re pleased to put this issue behind us and avoid the cost and expense of litigation."
U.S. Attorney Jay Clayton said CVS engaged in a "decade-long practice of repeatedly prematurely refilling insulin prescriptions for patients and improperly billing government healthcare programs for more insulin than patients needed."
"These programs rely on pharmacies to follow appropriate refill schedules and to accurately report the amount of medicine dispensed, which CVS pharmacies frequently failed to do. This settlement reflects our continued commitment to holding pharmacies to account, enforcing rules designed to keep costs down, and protecting taxpayer dollars," Clayton said in a statement.
