(The Center Square) – The Oklahoma Insurance Department (OID) has reached a $4.8 million settlement with CVS Caremark over its collection of Medicare Part D and Employee Retirement Income Security Act (ERISA) plan claims, according to a news release.
Oklahoma pharmacies will receive $2.3 million of the claim, and the remainder of the $2.5 million is assessed as penalties.
CVS Caremark is a pharmacy benefits manager (PBM). State lawmakers passed the Patient’s Right to Pharmacy Choice Act (PRPCA) in 2019. It regulates PBMs, which act as a middleman between patients and insurers. In some cases, PBMs may influence the costs of prescription drugs and what drugs are covered, according to the OID.
The Pharmaceutical Care Management Association challenged the law in court, saying federal law prohibits the regulations. The case is pending in the U.S. District Court in the Western District of Oklahoma. The settlement is contingent upon the outcome of the case, according to the news release.
"While questions remain about the extent to which enforcement of the Patient’s Right to Pharmacy Choice Act may ultimately be preempted by federal law, we must not stand idle while fees charged in violation of the law are being paid by Oklahoma businesses and consumers," OID’s Director of PBM Compliance and Enforcement Kelli Price said.
The investigation began in September 2020.
"CVS Caremark was cooperative during our investigation, we were able to work together through negotiations to ensure there is a level playing field that is abiding by the rules of PRPCA and other PBM statutes,” Oklahoma Insurance Commissioner Glen Mulready said. “With the rising cost of healthcare throughout the pandemic, it is more important than ever to ensure companies fully comply with our laws to protect consumers and other businesses.”
The Legislature passed a bill last year that would have added new restrictions to PBMs, but it was vetoed by Gov. Kevin Stitt.
The bill would have defined a PBM as any entity conducting pharmacy benefit manager activities and allowed pharmacists to discuss the costs of prescriptions.
via Oklahoma's Center Square News