The lawsuit, filed April 26 in the U.S. District Court in Eastern Oklahoma, claims pharmacy benefit managers and health plans run by UnitedHealth and CVS rejected or hindered the nation’s claims for reimbursement.
In 2015, the nation’s pharmacies began experiencing “numerous and unprecedented claim denials” for “covered drugs for which the nation had previously submitted and received reimbursement without issue,” the lawsuit alleges. The nation claims the denials are based on rules that the nation is exempt from.
The nation also alleges that UnitedHealth and CVS “effectively compel” it to participate in drug discount programs that lead to losses for the nation. The nation seeks payment for all withheld costs of pharmacy services.
Becker’s Hospital Review reached out to UnitedHealth and CVS for comment on the lawsuit. Both companies said they are not commenting on the allegations.
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.