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CVS Caremark is paying $5 million to the state of Oklahoma to settle allegations that it paid pharmacies in that state less for drugs than what the medications actually cost.
Oklahoma Attorney General Gentner Drummond announced the settlement with CVS Health's pharmacy benefit manager on Monday.
CVS Caremark will pay $5,081,520.69 to the Attorney General's Office. The money will repay pharmacies for 68,099 prescriptions filled between January 2024 and August 2025 for which they were paid less than what the drugs cost them, the AG said.
Seventy-five percent of the fines will go to the affected pharmacies, while 25% will support the Attorney General's continued oversight of PBMs, the AG said.
The settlement includes fines and covers the state's investigation costs.
CVS Caremark denies any wrongdoing and agreed to the settlement to avoid the costs and uncertainties of continued litigation, according to the release.
WHY THIS MATTERS
PBMs determine how much pharmacies get paid for dispensing prescription drugs.
CVS Health posted on its website that pharmacy benefit managers design and administrate cost-effective prescription drug plans on behalf of clients.
"When your local pharmacy is paid pennies on the dollar, or even loses money filling your prescription, it can't keep its doors open," Drummond said. "This settlement puts millions of dollars back into Oklahoma pharmacies so they can continue serving their communities. We're protecting your access to the prescriptions you need and the pharmacists you trust, especially in small towns where the local pharmacy is often the only option for healthcare."
The Attorney General's Office said it would notify each eligible pharmacy in writing and provide instructions for receiving payments under the settlement. Pharmacies that believe they were paid below cost are encouraged to file complaints with the PBM Compliance and Enforcement Unit.
In addition to monetary relief, CVS Caremark has agreed to reforms including reviewing pharmacy payment disputes against national cost benchmarks, allowing pharmacies to use documentation of actual costs when challenging payments, responding to disputes within 10 calendar days as required by Oklahoma law, and working with the Attorney General's Office during a 90-day period to resolve additional complaints.
THE LARGER TREND
In September, the Oklahoma Attorney General’s Office announced a $32 million settlement with CVS Caremark, resolving claims that the PBM withheld discounts and rebates intended for state employees, according to Oklahoma News4.
CVS Caremark retained millions of dollars in pharmaceutical discounts and rebates meant for Oklahoma Health Choice, a plan benefiting state employees, explained Attorney General Gentner Drummond. As part of the settlement, CVS Caremark will pay $32 million, with $27 million allocated directly to Health Choice after legal fees are deducted.
CVS Caremark denied any wrongdoing, stating that the resolution was reached to avoid litigation costs.
Email the writer: SMorse@himss.org