Connecticut joins lawsuit alleging CVS overcharged Medicaid programs

CT Post – Friday, May 9, 2025
By Cris Villalonga-Vivoni

Attorney General William Tong announced this week that Connecticut is joining three states in a whistleblower civil action lawsuit against CVS Health, Inc., adding to his already lengthy roster of recent federal lawsuits.

The lawsuit claims that CVS Health and its subsidies overcharged the four state’s Medicaid programs for prescription drugs after submitting “false and fraudulent claims,” violating state law.

It was filed in the Washington D.C. judicial district under the whistleblower provisions and federal False Claims Acts. Tong joins the attorneys general from Massachusetts, Indiana, Oklahoma on the suit “to recover treble damages, restitution and penalties” for the fraud.

“Connecticut’s laws exist to ensure fair, transparent drug pricing in Medicaid. CVS knew those laws, and they did not comply,” Tong said in a press release. “We are committed to protecting the integrity of our taxpayer-funded healthcare programs.”

CVS Health strongly disputes the allegations of inaccurate or inflated prices for Medicaid, said a spokesperson for the company. In an email statement to CT Insider, the spokesperson added that many pharmacies, including CVS, have been defendants in other lawsuits accusing them of submitting inflated usual and customary prices over the years and prevailing many times.

“We’ve always been transparent with Medicaid programs concerning the prices we were submitting,” the spokesperson wrote. “The four states involved in this lawsuit have never issued guidance to pharmacies contending that third-party discount card prices constitute a pharmacy’s usual and customary prices.”

According to the complaint, CVS Health started using a third-party vendor, ScriptSave, to administer a prescription discount program in 2016. The program offered cash-paying customers with a discount lower than what CVS reported to the states’ Medicaid as its the usual and customary prices, or the average price a provider typically charges.

The goal of reporting the prices, the lawsuit explains, is to make sure Medicaid is not paying higher than other health payers. Tong’s office said that an investigation found prescription drugs that the state Medicaid program paid more for than the customers using discount cards. It adds that this violates state law that states Medicaid must be billed at the lowest discount program price.

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