Whistleblowers Spark DOJ Intervention
The DOJ stepped in after reviewing 10 whistleblower lawsuits alleging that CVS staff were directed to submit claims using the maximum allowable days of supply for reimbursement—often a number lower than the actual supply dispensed to patients.
Clayton described CVS’s alleged practices as “a decade-long pattern” of prematurely refilling insulin prescriptions and billing government programs for excess quantities.
Management Knowledge and Audit Red Flags
Federal prosecutors say CVS management knew about the discrepancies. Pharmacy benefit managers (PBMs), acting as watchdog intermediaries, reportedly flagged dispensing violations in audits and issued chargebacks. But despite repeated warnings, CVS allegedly failed to implement corrective measures.
CVS Defends Its Practices Amid Complexity
A spokesperson for CVS told Law360 that insulin pen billing is “incredibly complex,” pointing to FDA labeling changes, limited packaging options, dosing variability and differing insurance requirements.
“While we do everything we can to ensure patients get the medications they need, insulin pen billing has long been a challenge for pharmacies,” the spokesperson said.
