Local pharmacies sue CVS and its PBM

A proposed class-action lawsuit was filed Sept. 26 against CVS Health and CVS Caremark because of allegations the PBM required pharmacies to pay fees for Medicare Part D prescriptions.

Advertisement

An independent pharmacy in Iowa accused CVS Caremark — which accounts for a third of the pharmacy benefit manager market — of forcing local pharmacies to pay direct and indirect remuneration fees. 

The DIR fees are an “exploitation” of a loophole that allows PBMs to request money for Medicare Part D prescriptions months or years after they were filled, according to court documents. Caremark and other PBMs allegedly ask for these fees based on performance measures they determine. 

“For over half a decade, CVS Caremark has imposed increasing DIR fees on independent pharmacies based on ‘performance criteria’ metrics, many of which make no sense for pharmacies,” the lawsuit, which seeks to be a class-action case, alleges. 

A CVS spokesperson told Becker’s the allegations are meritless and the company plans to defend itself.

At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.

Advertisement

Next Up in Legal & Regulatory Issues

Advertisement

Comments are closed.