Health Plans Say CVS, Pharmacy Middlemen Hid Prices

CVS Pharmacy Inc. conspired with several of the nation’s largest pharmacy middlemen to hide the lowest prices they offered for generic drugs, two union health plans say.

The allegations against CVS, its pharmacy benefit manager subsidiary Caremark Rx, and other PBMs, including Express Scripts Inc. and UnitedHealth Group Inc.’s OptumRx Inc., adequately stated federal racketeering claims, Chief Judge William E. Smith of the U.S. District Court for the District of Rhode Island said. Smith allowed the plaintiffs to add the claims to their original fraud complaint against CVS.

The claims against CVS and the PBMs are emblematic of an increasing wave of criticism aimed at retail pharmacies and PBMs over allegedly unfair drug pricing practices. In February, independent pharmacists in Arkansas complained about CVS Caremark’s reimbursement rates. The group is calling for legislation that would provide greater state oversight of all PBMs operating in the state. Iowa, Kentucky, New Mexico, New York, Texas, and West Virginia are among the states currently grappling with similar PBM reimbursement issues.

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By Dana A. Elfin

From Health Care on Bloomberg Law