Oklahoma Attorney General Gentner Drummond has initiated two significant legal actions against CVS Health and its subsidiary, CVS Caremark, focusing on alleged Medicaid fraud and violations by pharmacy benefit managers. In May 2025, Drummond filed a complaint against CVS Pharmacy, asserting that from 2016 to at least 2022, the company violated Oklahoma’s False Claims Act.
The allegation centers on CVS charging Medicaid programs higher prices than those offered to the general public, thereby misrepresenting the 'usual and customary' prices to secure inflated reimbursements. This practice purportedly led to fraudulent claims against Oklahoma’s Medicaid program, SoonerCare, resulting in the misuse of taxpayer funds.
The complaint, unsealed in April 2025, is part of a broader legal effort joined by Indiana, Connecticut and Massachusetts to recover misappropriated Medicaid funds.
Earlier, in January 2025, Drummond'sofficesuedCVS Caremark, the PBM arm of CVS Health, accusing it of under-reimbursing 15 independent Oklahoma pharmacies for prescription drugs. The lawsuit claims that between MayandOctober2024, CVS Caremark reimbursed pharmacies below the actual acquisition cost for approximately 200 prescriptions, violating state laws designed to protect pharmacies from such practices.
This case is notable as it is the first to be heard in Oklahoma's newly established PBM Administrative Court, reflecting the state's intensified scrutiny of PBM operations. Drummond emphasized the detrimental impact of these practices on independent pharmacies, particularly in rural areas, where closures have left communities without essential healthcare services.
He highlighted that his office has received over 3,100 complaints regarding PBM practices, including unfair reimbursement and burdensome fees. CVS Health has acknowledged the allegations and stated that it is reviewing the complaints.
A spokesperson for the company mentioned that CVS Caremark is committed to delivering value to its clients and will respond to the allegations in due course. These legal actions are part of a nationwide trend where states are increasingly scrutinizing PBMs for practices that may inflate drug prices and harm independent pharmacies.
The Federal Trade Commission reported that the three largest PBMs, including CVS Caremark, collectively gained $7.3 billion by marking up drug prices, prompting further investigations and regulatory actions across various states. These developments underscore Oklahoma's commitment to ensuringfairpharmaceutical practices and protecting both taxpayers and independent pharmacies from alleged corporate misconduct.