NEW YORK — Federal prosecutors said CVS Pharmacy will pay $37.76 million to resolve accusations that the company repeatedly dispensed more insulin to patients than their prescriptions required and improperly billed government health programs for the excess.
The settlement, announced by the U.S. Attorney’s Office for the Southern District of New York, ends a lawsuit claiming CVS submitted inaccurate claims for insulin pens between 2010 and 2020. The government claimed the pharmacy chain sought reimbursements for refills issued far sooner than patients needed, and under-reported how long each refill was meant to last.
According to prosecutors, the practice led to government programs, including Medicare, Medicaid, TRICARE and the Federal Employees Health Benefits Program, paying for medication that was ineligible for reimbursement. The company admitted it dispensed more insulin than required and received payments for refills that should not have been approved, according to the attorney’s office.
U.S. Attorney Jay Clayton said CVS’s actions created a decade-long pattern that bypassed safeguards meant to ensure pharmacies follow refill timelines and accurately track medication supplies.
The government’s complaint detailed that CVS sometimes submitted claims using the maximum allowable “days-of-supply,” even when dispensing a full insulin pen carton exceeded that limit. Investigators said those reporting practices made it harder for pharmacy benefit managers to detect early refills and allowed excess insulin to accumulate for some patients, a risk given the medication’s expiration window.
Of the settlement amount, $24.4 million will go to the federal government, with the remainder paid to participating states.
The attorney’s office said CVS did not contest the outlined conduct in the settlement, which was approved by U.S. District Judge John G. Koeltl.