The West Virginia Office of the Insurance Commissioner (OIC) issued a $1.4 million fine to CVS Caremark based on 2,871 violations of several provisions of the 2021 Pharmacy Audit Integrity Act. The OIC said CVS Caremark improperly applied the definition of “rebate” when withholding rebate payments and fees from the health plan, recouped excessive funds from pharmacy claims relative to the financial harm associated with the dispensed products, and exceeded the maximum number of prescriptions covered in a pharmacy audit.
The company also delivered contracts and communications to providers that cited fees associated with the cost of pharmacy audits in excess of those allowed by law and unreasonably designated 65 covered prescription medications as specialty drugs.
The commissioner ordered CVS Caremark to file a plan to address the violations within 30 days and is allowing 90 days to implement it. In the meantime, CVS Caremark requested a stay of the penalty order through the state’s Supreme Court of Appeals. The OIC previously fined CVS Caremark for reimbursing pharmacies below the required commercial market benchmark of NADAC plus the state Medicaid program’s professional dispensing fee.
