A former CVS executive has filed a whistleblower lawsuit that accuses the retail pharmacy chain of denying Medicare recipients access to less expensive generic drugs.
By denying seniors generic drugs, CVS has amassed astonishing profits for itself while passing the increased costs on to taxpayers and Part D beneficiaries, the whistleblower lawsuit alleged, according to STAT News.
The lawsuit was filed June 16 by Alexandra Miller, who worked at the company for two decades before leaving in 2019. Miller allegedly raised concerns about the scheme to a superior but was told that the benefits outweighed the risks of the plan being divulged.
Members of the CVS SilverScripts Part D plan were not informed about drugs that are identical in formulation to the more expensive branded medicines made by the same manufacturer as the name-brand drug. This practice, the whistleblower lawsuit alleges, violates Medicare regulations because it does not disclose this similar drug action. Moreover, the lawsuit claims that SilverScripts D customers were less likely to complain about the higher costs of the drug because their plan would cover the higher cost of the medication.
Caremark, a company that manages the pharmacy benefits for CVS’ SilverScripts Part D Medicare plan, is named as a co-defendant in the lawsuit. Caremark is accused of working with CVS SilverScripts to push branded medications onto seniors in order to pocket high rebates.
Pharmacy benefit management companies (PBMs) such as Caremark have recently come under increased scrutiny by the Federal Trade Commission over their business practices. After a recent Supreme Court ruling, PBMs may face tighter regulations at the state level.
The Department of Justice was asked to join the whistleblower suit but declined. CVS announced that it would vigorously defend itself against the lawsuit.