Boston, MA – Attorney General Andrea Joy Campbell’s office recently announced that it has reached a $6.15 million settlement with CVS Pharmacy, Inc. to resolve allegations that it failed in some instances to follow prescription pricing procedures that are in place to keep costs down and prevent overcharges in the workers’ compensation insurance system.
The assurance of discontinuance, filed in Suffolk Superior Court, alleges that in some circumstances CVS failed to follow Massachusetts law and regulations that help keep costs low in the Massachusetts workers compensation insurance system. Under state regulations, various benchmarks – like the Federal Upper Limit for Medicare and the Massachusetts Maximum Allowable Cost – must be reviewed when making pricing determinations for certain workers’ compensation insurance prescription drug charges. The AG’s settlement identified alleged failures concerning prescriptions filled in Springfield, New Bedford, Boston and Worcester CVS locations.
“The state’s workers’ compensation system operates at its best when it is functional, transparent and affordable,” said AG Campbell. “Ensuring that pharmacies follow procedures and do not drive-up costs in our workers’ compensation system is an important priority for my office, and we will continue to advocate to keep this critical system available and accessible on behalf of workers and employers.”
When employees are hurt on the job, they are entitled to lost wages, compensation for injuries, and payments for certain injury-related expenses, under the Commonwealth’s Workers’ Compensation system. The system sets limits for the cost of prescriptions for injured workers and requires companies to validate prices against certain regulatory benchmarks before processing their charges.
Under the terms of the AG’s settlement, CVS will work with the Attorney General’s Office to seek improvements to the Massachusetts workers compensation billing system and establish procedures to prevent overcharges.
This case is part of AG Campbell’s ongoing review of prescription pricing procedures in the workers’ compensation system. The AG’s Office previously resolved matters concerning Express Scripts, Optum Rx, Walgreens, Stop & Shop, United Pharmacy, among others. Collectively, this effort has recovered over $20 million relating to workers’ compensation drug pricing procedure violations.
This case was handled by staff from the AG’s Insurance and Financial Services Division, including Gia Kim, Dr. Burt Feinberg, and Glenn Kaplan.
Source: MA AG’s Office