CVS & Walgreens Generic Drug Overcharge Lawsuit Investigation

Two lawsuits filed on August 7, 2017 against CVS and Walgreens alleges that the pharmacy companies overcharged insured customers for the following drugs:

Accu-Chek	Acyclovir	Aktob	Albuterol
Alocril	Alprazolam	Amiodarone	Amitriptyline
Amlodipine	Amoxicillin	Amphetamine	Anastrozole
Atenolol	Atorvastatin	Azelastine	Azithromycin
Bactrim	Benazepril	Benzonatate	Betamethasone
Buspirone	Bystolic	Carvedilol	Cefadroxil
Cefdinir	Cephalexin	Cetirizine	Ciprofloxacn
Citalopram	Clindamycin and Benzoyl Peroxide	Clindamycin	Clonazepam
Clonidine	Clopidogrel	Cyanocobalam	Cyclobenzaprine
Cytomel	Denta	Depo-Testosterone	Diazepam
Dicyclomine	Diltiazem	Doxazosin	Doxycycl
Duloxetine	Enalapril	Escitalopram	Estradiol
Eszopiclone	Feosol	Ferrous	Flonase
Fluconazole	Fluocinonide	Fluoxetine	Fluticasone
Folbee	Folic	Furosemide	Gabapentin
Gemfibrozil	Gentamicin	Gianvi	Glimepiride
Glipizide	Guaifenesin	Hydrochlorot	Hydrocodone/APAP
Hydroxyz	Ibuprofen	Indomethacin	Invokamet
Irbesartan	Isosorbide	Januvia	Lamotrigine
Lantus	Latanoprost	Levetiraceta	Levocetirizi
Levofloxacin	Levothyroxine	Lexapro	Lisinopril
Hydrochlorothiazide	Lisinopril	Lisinopril/hydrochlorothiazide	Lithium
Loratadine	Lorazepam	Losartan	Losartan and Hydrochlorothiazide
Lovastatin	Meloxicam	Memantine	Metformin
Methocarbam	Methylphenidate	Metolazone	Metoprolol
Metronidazol	Minivelle	Mirtazapine	Mometasone
Montelukast	Mupirocin	Naproxen	Nitrofurantoin
Nortriptylin	Nystatin	Omeprazole	Ondansetron
Oxcarbazepin	Oxybutynin	Oxycodone/APAP	Pantoprazole
Paroxetine	Penicillin	Percocet	Pramipexole
Pravastatin	Prednisone	Prednisolone	Promethazine/Codeine
Ramipril	Ranitidine	Restasis	Sertraline
Simvastatin	Singulair	SMZ/TMP	Sodium Chloride (1 gm)
Spironolactone	Sprintec	Sulfameth/Trimeth	Sumatriptan
Suprep	Synthroid	Tamiflu	Tamsulosin
Temazepam	Terazosin	Terbinafine	Tizanidine
Tobramycin/Sus Dexameth	Topiramate	Tramadol	Tranex
Trazodone	Tretinoin	Triamcinolone	Triamterene and Hydrochlorothiazide
Vagifem	Valacyclovir	Valsartan/hydrochlorothiazide	Valsartan
Vaniqa	Venlafaxine	Ventolin	Viagra
Vigamox	Vitamin D	Vyvanse	Warfarin
Xopenex	Zaleplon	Zolpidem

Lawsuits Allege Benefits Providers Received Kickbacks

The two lawsuits against CVS and Walgreens allege that the pharmacies overcharge insured customers for generic medication because they are required to pay a kickback to Pharmacy Benefits Providers (PBMs), who act as an intermediary between the pharmacies and insurance companies. The complaints allege that CVS and Walgreens have “secret, undisclosed written contracts” with the PBMs providing a kickback (or “clawback”) on the sale of certain medications, if the customer goes through insurance. The largest PBMs are Express Scripts, CVS Caremark, and OptumRx. The complaints say that in many of CVS’s and Walgreens’s agreements with the PBMs, “CVS pledges” and “Walgreens pledges” to “not inform clients that they could pay less if they did not use their insurance plans.”

Patients who have a deductible for the prescription drugs are at risk for having overpaid, the plaintiffs allege. For example, the plaintiff in the CVS case alleged that she had gone through insurance and paid $165.68 for a drug for which CVS only charged $92 out-of-pocket. The plaintiff against Walgreens says that he went through insurance and paid $21.80 for a drug for which Walgreens only charges $10 out-of-pocket.

The lawsuits also say that patients who paid a co-pay for their generic drugs, even a co-pay as low as $10, may have overpaid. For example, the complaint shows a patient with United Healthcare was charged a co-pay of $10 for Lisinopril, but the pharmacy only received $7.23 and paid a “clawback” to the PBM of $2.77. Paying for the Lisinopril out of pocket may have been cheaper.

Pharmacists have acknowledged these practices, say plaintiffs. Pharmacists have said:

• “[PBM] charging a patient $125 for a generic drug and take back $65 from the pharmacy. If paid cash the cost to the patient would have been $55.”
• “A patient copay is over $50 and the claw back is over $30 all for a drug where our cash price would only be $15.”

NY Dept. of Health: Insured Customers Who Paid $15 or More for Generics May Have Overpaid

According to statistics from the New York Department of Health showing CVS’s retail drug prices, customers with co-pays as low as $15 may have overpaid. For example, the retail price for Levothyroxine is listed as $11.99 for most CVS locations. Anyone who went through insurance and paid $15 or more as a co-pay or as part of a deductible may have gotten Levothyroxine for cheaper had they paid out-of-pocket and not gone through insurance.

A chart is below showing the ten most prescribed generic drugs and their CVS retail prices, according to the New York Department of Health website. If you went through insurance and paid more to CVS than the prices listed in the right-hand column, you may have overpaid.

Generic Drugs1	Common Brand Names	CVS Retail Price2
Hydrocodone/ acetaminophen	Vicodin	$17.39
Lisinopril	Zestril, Prinivil	$16.19
Levothyroxine	Synthroid, Tirosint, Levoxyl	$11.99
Atorvastatin	Lipitor	$107.99
Amlodipine	Norvasc	$61.59
Simvastatin	Zocor	$37.99
Omeprazole	Prilosec	$59.59
Metformin	Glumetza, Glucophage, Fortamet	$17.99
Amoxicillin	Moxatag	$16.89
Hydrochlorothiazide	Microzide, Diovan, Dyazide, Maxzide-25, Hyzaar, Zestoretic	$14.49

1. Source: IMS Health
2. New York Department of Health, Prescription Drug Prices in New York State, available at https://apps.health.ny.gov/pdpw/SearchDrugs/Home.action. (Searches done for Manhattan area. Where prices differed by location, lowest price is displayed).

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