CVS agrees to pay $37.8 million to resolve insulin pen claims.

CVS Health has agreed to pay $37.76 million to resolve allegations that it distributed excessive insulin pens to patients and sought improper reimbursements from Medicare, Medicaid, and other government healthcare programs, according to U.S. authorities in Manhattan.

The settlement addresses claims that CVS violated the federal False Claims Act from January 1, 2010, to December 31, 2020, by dispensing more insulin pens than prescribed, submitting claims for early refills, and underreporting the volume of insulin distributed at its pharmacies.

Authorities said CVS reportedly directed pharmacy staff to record the maximum days-of-supply when dispensing full insulin pen cartons, aiming to process prescriptions faster and ensure approval of reimbursement claims. Insulin pens are used by diabetes patients for self-administered insulin injections.

The payout allocates $24.45 million to the federal government, with the remaining portion distributed among various U.S. states.

CVS, headquartered in Woonsocket, Rhode Island, stated that billing for insulin pens has historically been challenging due to labeling changes, dosage variations, packaging differences, and differing supply limits set by payors. The company added that recent developments in pharmacy benefit management and payor practices have eased some of these difficulties. CVS expressed satisfaction in closing this matter through the settlement.

This resolution settles a Department of Justice lawsuit along with several whistleblower cases. The initial case was filed in 2018 by Adam Rahimi, a CVS pharmacist. Whistleblowers are set to receive 19.5% of the settlement, with Rahimi receiving the largest share.

Author: Chloe Ramirez