CVS Caremark agrees to settle transaction fees
The Oklahoma Department of Insurance has reached a settlement with CVS Caremark over the transaction fees charged by pharmacy benefit managers to pharmacists for processing Medicare Part D and group health plan claims, the agency announced Thursday.
The CVS Health subsidiary will pay $4.8 million to resolve alleged violations of the state’s Patient Pharmacy Choice Act. CVS Caremark will pay the pharmacy $2.3 million in damages and pay the state $2.5 million in fines.
“CVS Caremark has been very cooperative in our investigation process and we were able to negotiate and work together to ensure there is a level playing field that follows the rules [Patient’s Right to Pharmacy Choice Act] and other PBM regulations,” Oklahoma Insurance Commissioner Glen Mulready (R) said in a news release. “As health care costs rise throughout the pandemic, ensure companies are fully compliant with our laws to protect consumers and Others are more important than ever. enterprise. “
CVS Caremark did not respond to a request for comment.
However, the Oklahoma statute supporting the CVS Caremark settlement is the subject of a federal legal battle. The Pharmaceutical Care Management Association, a PBM industry group, filed a lawsuit arguing that the federal Employee Retirement Income Security Act, which administers workplace benefit plans, takes precedence over state law. If plaintiff wins, CVS Caremark will not have to pay Oklahoma or the pharmacy. CVS Health is a PCMA member.
A federal appeals court ruled in November that North Dakota’s requirements for pharmacy benefit managers comply with ERISA, potentially setting a precedent for similar lawsuits. North Dakota prohibits companies such as CVS Caremark from taking stakes in patient assistance programs or mail-order specialty pharmacies.
While it upheld North Dakota’s statute, a federal court ruled that the state cannot cap pharmacy benefit managers’ fees because it conflicts with laws related to Medicare Part D.