Mid-Year Review: CVS Vs 30 States and More Healthcare Lawsuits
I know there is a LOT going on, but someone needs to keep up on our exploitative healthcare robber barons
Happy mid-year review day! Oh, just me… Anyway, I just had to complete my midyear review. For Aetna, it’s “Please tell us how hard we can exploit you! WORK HARDER!”
So, I decided to take that concept and turn it around on these chuckle fucks and bring to my audience a little mid-year review of my own.
CVS was caught lobbying in Louisiana… Via text.
Hey, what level of dystopian are we at when a corporation sends lobbying texts?
That’s not rhetorical, by the way. CVS is now involved in a class-action lawsuit because of this text in LA (The state, not the city):
This is not my text. I found this out after the fact.
So, here is one of the two bills:
One of the targeted bills, House Bill 264, passed and will require PBMs to share more rebates and discounts with patients and employer plans. It also prohibits PBMs from steering patients to certain pharmacies, a practice critics say favors companies like CVS, which both manages benefits and owns retail pharmacies.
All of this is accurate. Moreover, if you follow me at all, you would know that this company treats its workers about as well as Amazon (Adult diapers expected). By the way, the drive-thru sensor on my local CVS’s drive-thru has been broken since… I want to say December? So they had the money to send a mass text to their customers (Who likely did not consent to lobbying text. These people just want to know if their meds are ready), but can’t fix a fucking sensor? Yeah, OK.
The lawsuit, filed by Broussard, David & Moroux, claims CVS used confidential patient information to fuel its political campaign against the bills, a move attorneys say violated patient privacy and state laws.
CVS again defended its use of the mass text, saying it was consistent with the law.
Gov. Jeff Landry has instructed the Attorney General’s Office to investigate the texts.
. Let’s hope they lose. It’s already pretty bad with corporations owning fucking everything, but I would really rather not have a corpo text me lies about a law that will do nothing but hurt their bottom line.
CVS vs. Arkansas (CVS suing over new law)
You all know I am such a raging left-wing lunatic, I got my guns back, metaphorically speaking. Why are the red states getting this shit done?
Fascist cowboy barbie Sarah Huckabee-Sanders signed into law a bill that would ban PBMs with retail pharmacies from utilizing distribution, effectively banning the pharmacy. I actually found this out during a town hall. They are really pissed.
They claim that this is “Bad policy” and that “it will cause the cost of drugs to skyrocket”
They actually claim this kind of shit all the time. According to the guy who runs Caremark, we also created formulary exclusions. Remember that poor kid who died because his asthma inhaler went from $60 to $600 overnight? This is because the medicine he took was taken off the formulary. Aetna started this. With insulin and HGH. The claim is that insulin prices dropped when they did this in 2012. It’s not true:
If you look at this chart, 2012 was when the prices really started to increase. This is, again, because of our “vertically aligned” corporate bullshit. And gaslighting. Corporations are great at gaslighting.
From someone who works there, trust me. They breathlessly talk about the harm to patients if they can’t price gouge, and in the next talk about how much money they’re projecting to make through their PBM.
The PBM is the big money-maker. Much of their money comes from the PBM. If they can’t use the PBM to control the reimbursement amounts (Undercutting competing pharmacies and giving much higher reimbursement to their own.), they will lose a ton. Aetna is projecting almost $400 BILLION in revenue, y’all. From your premiums and denied treatments.
Anyway, next lawsuit!
Pennsylvania vs. CVS outcome
A lawsuit in PA just finished, resulting in a $95 million dollar judgment against CVS. Here is the legal brief in its entirety.
A former Aetna actuary in the Medicare department won a $95 million False Claims Act judgment (PDF) against pharmacy benefit manager Caremark on Wednesday. She alleged Caremark prompted health insurers to misrepresent to the government the price paid for prescription drugs for Medicare beneficiaries. Importantly, the lawsuit claimed Caremark contracted with pharmacies to pay a fixed average price but caused higher prices to be reported.
Also named in the lawsuit were SilverScript Insurance, Walgreens and Rite Aid.
Remember, they’re just fucking liars. They constantly do this shit. Because you can’t just go shop for cheaper meds if you are stuck using one of the pharmacies tied to their brand.
“Unlike the contractual GER guarantees, the budgeted GERs between Caremark and CVS Pharmacy did not provide for a reconciliation or ‘claw back’ if Caremark underpaid relative to the budgeted GER,” the lawsuit explained, noting Caremark did not make any true-up payment to the pharmacy business in 2015, as would have been required otherwise.
Basically, if they decided to underpay a competitor, there was no recourse to get their money owed. I’ve seen this shit happen with other providers as well when looking at claims. It’s insane.
CVS is hit with two other lawsuits in LA
Two other lawsuits have been filed over that lobbying text. (Legal briefing here for the first one)
“I believe CVS used their customers' personal information that was given to them to fill their prescription, to lobby for their own corporate interests against pending legislation in the State Legislature,” she said in a statement. “PBMs are not managing the costs of drugs—they are driving the price up! CVS and other PBM’s continue to hide behind various confidentiality clauses to cover up the way they are manipulating drug prices—it’s wrong and unlawful.”
No, I did not consent for this company to send me lies. But then there’s more!
Another lawsuit (PDF) says Caremark’s grip on the pharmaceutical supply and reimbursement chain gives CVS unwarranted power through horizontal and vertical integration. Additionally, the attorney general says Caremark’s use of rebates and a group purchasing organization allows the company to “obscure” costs and “enable double dipping of rebates and administrative fees.”
Basically, all those “savings” aren’t passed on to their customers. It’s passed to the executives in the team, so Steve can get a new house.
But wait, there’s even more!
Finally, a third lawsuit (PDF) says CVS abuses its market power to impose “exceedingly high fees” on other pharmacies. The company practices spread pricing, a tactic opposed by bipartisan lawmakers at the federal level, and threatens to exclude pharmacies from its network, Murrill said.
This is how they control the supply chain. Either by excluding pharmacies or by jacking up the fees. This is why PBMs exist. There is no reason for them. Instead of pharmacies working directly with the manufacturers, they have to do through a PBM for… some reason? It makes 0 sense, and PMBs shouldn’t exist.
CVS vs. Over half the US
One thing that seems to be bringing Americans together is hatred of these fucking insurance companies. 30 fucking states are suing CVS in a joint lawsuit.
States are joining a Massachusetts lawsuit alleging Medicare fraud. I’ve mentioned this before in my notes.
Nearly 30 states have joined in on a lawsuit filed by Massachusetts Attorney General Andrea Joy Campbell against CVS Health and its pharmacies. The lawsuit accuses the pharmaceutical giant of submitting "false and fraudulent" claims to Medicaid programs operating in the states named as defendants. The complaint originally included four states, California, Connecticut, Indiana, and Massachusetts, but would grow to include more than two dozen states, including Washington, D.C.
Basically, it’s a bait and switch.
The discount program was operated by a company called ScriptSave. Together, ScriptSave and CVS allowed customers to pay significantly lower prescription costs while billing Medicaid patients much higher costs for the same prescriptions. The lawsuit explains that CVS did not report the discounted rates to the states' Medicaid programs. It continues that since 2016, CVS did not submit its customary prices available to other payers on prescription drug claims to Medicaid. As a result, Medicaid was overpaying for prescription drug costs as compared to other health plans available.
They overbilled Medicaid Patients. If you’re on Medicaid, you’re either disabled or poor. How the fuck is this OK? Then again, they jacked the price of a specialist for certain plans from $30 to $80 (I forget which one, but I did email Steve asking him to justify it. He didn’t reply because he doesn’t know me from Adam and doesn’t actually care.)
So they took advantage of the most vulnerable. And they got away with it for years. This is in addition to the other lawsuits from last year when they were sued in Ohio for horrible working conditions, and malfunctioning drug containment.
CVS Sued over HIV drugs (I missed this one last year)
This is one from last year, but it’s relevant, especially in our political climate:
The litigation, initiated in February 2018, centers around the practices of CVS Caremark, the pharmacy benefit manager division of CVS Health. The plaintiffs allege that CVS Caremark and associated employer health plans unjustly forced them to obtain necessary HIV medications exclusively through CVS Caremark’s specialty pharmacy. This requirement, they argue, restricts their access to community pharmacies and deprives them of critical in-person pharmaceutical care and counseling, which are crucial for managing the complex medication regimens typical in HIV treatment.
CVS does this with all specialty medications, by the way. This is not the first time they’ve been in hot water. There have been some lawsuits alleging that sending certain drugs (especially temperature-sensitive ones) leads to delays in treatment and wasted drugs, as occasionally the deliveries are not handled with care and can end up damaging the containers.
It’s unfortunately standard practice.
And this is just CVS. I didn’t get to TOUCH any of the other ones.
We need to continue the push
These lawsuits are coming about recently because of the massive backlash the insurance industry is facing now that they’ve been exposed as the pieces of shit they are.
So we need to continue to reach out to our reps and encourage them to file more lawsuits. We also need people harmed by them to file lawsuits, exposing how little they give a shit if we live or die. These suits bring to the light, through their discovery phase, of things that they do not want you to know.
I work there, and I am not kidding when I say that they do not care about you other than to make money for shareholders. That’s why my own fucking insurance is unaffordable for most things. You out here reading this? You’re nothing to them. Likewise, you’re a number on a spreadsheet. They will do anything to get you stuck, and then you’re fucked. But what they don’t know is that you do have power. You have recourse. You have the media, you have attorneys, and you have whole ass departments to file complaints with. So next time your insurance denies your shit, appeal until you can’t, and then take it farther. File a complaint with the insurance agency and take to social media. Obviously, we are also seeing protesters including the fight for universal healthcare in their protests, and we need that. Hopefully, if we can continue to take it to them, we can finally get these assholes out of our healthcare.
Be safe everyone!
~Ana the Insurance Demon
Thank you for this analysis. I think I need to read it a few more times. I have a friend who develops SW for these PBM (or whatever the fuck they are). When she explained it to me, we were both aghast. Our 'joke' is that I worked for the DoD and probably killed less people. (riotous, I know)