Lawsuit: CVS Is Ripping Off Insured Customers by Overcharging Them for Meds

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A pedestrian walks past a CVS store in Philadelphia.
A pedestrian walks past a CVS store in Philadelphia. PA. AP Photo/Matt Rourke

A California woman is suing CVS Health Corp., alleging the drugstore chain overcharges customers for prescription copays.

The case may become a class-action suit.

“CVS deliberately charges customers who use their insurance more for the Affected Drugs as compared to customers who pay cash or simply don’t use their insurance,” the suit claims. “Affected Drugs” is the term used to describe certain generic medications that CVS allegedly overcharged for.

Plaintiff Megan Schultz’s story goes like this, according to the suit:

“On July 6, 2017, she used her insurance to purchase a certain generic drug at her local CVS, and under her plan she was required to pay $165.68. But if she simply paid in cash, without using her insurance, she would have paid only $92. CVS never told her that paying in cash would allow her to pay 45% less for the drug; instead, CVS remained silent and took her money—knowing full well that no reasonable consumer would make such a choice.”

The case accuses CVS of a host of violations, including racketeering (the best fancy word for fraud) and fiduciary conflicts of interest.

Michael DeAngelis, a spokesperson for CVS, told Bloomberg: “The allegations against us made in this proposed class action suit are built on a false premise and are completely without merit.”

How Pharmacies Negotiate Your Prescription Copays

This payment disparity occurs because of agreements between pharmacy benefit managers, who are third-party administrators who work with pharmacies and insurance companies to negotiate prices for prescription drugs. If a pharmacy can make agreements to accept customers from more insurance companies, it can get more people in the door to fill their prescriptions — and pay whatever copay the pharmacy charges, often without a second thought.

“The linchpin of the scheme,” the case states, “is that the consumer pays the amount negotiated between the PBM and CVS even if that amount exceeds the price of the drug without insurance.”

This strategy, in which the PBM keeps the difference between the copay and the cash price, is referred to as a clawback. This cozy relationship between PBMs and pharmacies continues until a customer notices.

Bloomberg followed this issue for a while, explaining clawbacks in a February report that highlighted gag clauses that prevent pharmacists from informing customers about lower cash prices. Some states have nixed these gag clauses.

How to Ensure You Get the Best Price for Your Prescriptions

Suddenly doubting all the prescription copays you’ve coughed up over the years?

There are a few steps you can take to avoid a situation like the one in this lawsuit.

When you get a new prescription, don’t be afraid to call the pharmacy and ask what the price is if you pay cash. If the drug you need is pricy or doesn’t come in a generic form, you can also ask if the pharmacist knows of any discount programs or coupons.

You can also search for your medication and dosage on LowestMed or GoodRx to compare prices in your area.

Consulting your insurance company’s drug formulary will let you know if your new prescription is covered and fill you in on the copay you can expect.

Think CVS overcharged you for prescription copays? We’ll update this post if the case becomes a class-action suit

Lisa Rowan is a writer and producer at The Penny Hoarder.