Just a couple of years ago, a whistleblower charged CVS with $1 billion in Medicare drug fraud. Now, CVS has been sued for overcharging Blue Cross Blue Shield for generic drugs. Healthcare Dive reports that Blue Cross Blue Shield is seeking millions of dollars in damages.
Blue Cross Blue Shield claims that, for more than ten years, CVS charged it a higher price for certain drugs than CVS was charging the general public for these drugs if they were paying cash for them. CVS denies the charges against it. It says they are without merit.
While Blue Cross Blue Shield had negotiated the price it paid for these generic drugs with CVS, Blue Cross claims it should have benefited from the lower price that CVS charged people who paid cash for them. Put differently, Blue Cross argues that the cash price should be the highest price it pays. And, it says that CVS used a discount program to keep Blue Cross from knowing the cash price.
The CVS membership program provides discounts on certain generic drugs to anyone who signs up. It also gives discounts to people who do not sign up, according to the Blue Cross lawsuit. The Blues argue that this membership program set the true cash price for the drugs, also referred to as the “usual and customary [U&C] price.” By concealing these prices in the membership program, insurers, including the plaintiffs, were not alerted to, and did not pay the lower U&C, or cash price.
According to the lawsuit, CVS “tried to find a way to both broadly offer discounts to retain critical pharmacy customers, including cash paying customers, and also avoid the unprofitable result of reporting the discounted prices as the U&C price.”
CVS argues the membership program prices were not the U&C prices. And, its membership program prices were neither concealed nor fraudulent.
Blue Cross Blue Shield is not the only company that has filed suit against CVS for fraudulent overcharges. The Sheet Metal Workers union and the state of Mississippi have also sued CVS for this behavior.
Here’s more from Just Care:
- Real risk of medication errors at CVS and other chain pharmacies
- CVS Caremark accused of $1 billion in Medicare drug fraud
- To save money on drugs, avoid chain pharmacies
- Aetna under investigation for denying care without appropriate review of medical records
- Coronavirus: For older adults, wearing gloves presents more risks than benefits
CVS just tried to charge me $111 for a no cost pharmacy flu and shingles shot. The pharmacy technician went on computer and typed for 15 minutes or more in this fraud. I refused to pay, I called my doctors office . Because Cvs said I opted out of my Medicare A And B, untruths. I am getting it for free at my Doctors office.