The office of the West Virginia Insurance Commissioner Allan McVey announced a consent order as part of administrative proceedings against CVS Caremark with an initial settlement of over $1 million for violations of the state’s reimbursement statute requiring a minimum of NADAC plus a professional dispensing fee of $10.49. The administrative proceedings looked at claims of ERISA plans from out of state serving patients in West Virginia since January 2023.
Under the consent orders CVS Caremark will review all claims and report findings to the state’s Office of the Insurance Commissioner, paying identified under-reimbursed claims with interest, and submitting a Corrective Action Plan. CVS Caremark had previously represented that computer software challenges were to blame for not being able to identify all impacted claims, so the above-mentioned proceedings may identify additional violations and result in additional fines.
