The CVS Caremark pharmacy benefit manager improperly reported generic drug prices to the federal government, causing Medicare and its beneficiaries to overpay for medicines, while pocketing a difference in pricing, according to a lawsuit filed by an actuary at the Aetna health insurer.
The lawsuit revolves around complicated, behind-the-scenes contracts between pharmacy benefit managers and Medicare Part D plans, and the pricing that must be reported to the Centers for Medicare and Medicaid Services.
In this instance, CVS Caremark allegedly paid pharmacies lower prices for generic drugs than what Medicare Part D plans were charged, despite regulations that require reporting the actual cost of a drug after any discounts or rebates that are passed along to companies that run, or sponsor, Part D plans. The improper reporting allegedly cost CMS and Medicare beneficiaries more than $1 billion.
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