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Class action lawsuits claim that chains colluded with PBMs to overbill customers.
Pharmacy customers have brought two lawsuits against CVS Health and Walgreens claiming that the chains overcharged them for certain prescriptions drugs. The suits state that customers paid more out of pocket for drugs when they used their health insurance than if they had simply paid cash because of collusion with third parties such as PBMs.
Megan Schultz, whose name is on the suit against CVS filed in Rhode Island, the company’s home state, claims that she paid $165.68 as a copay for a generic drug that would have cost her $92 if she had not used her insurance. David Grabstald, who filed suit in Chicago federal court against Walgreens, paid $21.80 in a copay for a generic that would have cost him $10. Neither had been told that they could pay less if they didn’t present their insurance card.
According to the Rhode Island suit, this practice of “clawbacks” in the copays is due to collusion between CVS and PBMs. The suit states that CVS and PBMs take part in “a fraudulent scheme,” through agreements based on “secret, undisclosed contracts.” Customers are not told that these agreements could result in their being charged more in copays than the price of the drug, the suit noted.
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“The allegations against us made in this proposed class action suit are built on a false premise and are completely without merit,” said Mike DeAngelis, Senior Director for Corporate Communications at CVS Health, in an email to Drug Topics. “Co-pays for prescription medications are determined by a patient’s prescription coverage plan, not by the pharmacy. Pharmacies collect the co-pays that are set by the coverage plans. Our pharmacists work hard to help patients obtain the lowest out-of-pocket cost available for their prescriptions. Also, our PBM, CVS Caremark, does not engage in the practice of co-pay clawbacks. CVS has not overcharged patients for prescription co-pays, and we will vigorously defend against these baseless allegations.”
Walgreens used the same language in an email to Drug Topics. “The complaint lacks merit and we will vigorously defend against the allegations,” said Walgreens Spokesperson Phil Caruso about the Grabstald suit.
The National Association of Specialty Pharmacy issued a statement about the CVS suit, calling for greater transparency in drug pricing. “Unfortunately, the current market dynamics and lack of transparency make it very difficult for patients and healthcare providers to navigate the increasingly complex healthcare and drug delivery system,” said NASP’s Executive Director, Sheila Arquette, in a statement.