Massachusetts AG Andrea Campbell settled with CVS Pharmacy, Inc. to resolve allegations that the company billed payors of workers’ compensation claims for prescription drugs in excess of amounts permitted by Massachusetts workers’ compensation laws and regulations. According to the settlement, AG Campbell alleges that various CVS locations in the Commonwealth failed to follow prescription pricing procedures in overcharging for prescription drugs provided to workers’ compensation insurance beneficiaries. Under the terms of the settlement, CVS must pay $6.15 million to Massachusetts, a portion of which will go towards restitution.
Massachusetts is the latest state to settle with health insurance giant Centene Corp. over allegations that it overbilled the state’s Medicaid program for pharmacy services. Centene, the nation’s largest Medicaid managed-care insurer, will pay $14.2M to the state. Before the Massachusetts agreement, Centene settled with Ohio, Arkansas, Illinois, Kansas, Mississippi, New Hampshire, New Mexico, Texas, and Washington for a total of $475M.
Ohio Capital Journal
The Massachusetts law permitting pharmacies and pharmaceutical manufacturers to offer drug discounts to patients, which was set to expire on January 1, 2023, has recently been extended to January 1, 2026. In its current form, Mass. Gen. Laws Ann. ch. 175H, § 3 allows pharmacies to provide discounts to patients. It also allows pharmaceutical manufacturers to provide discounts, rebates, product vouchers, and other price reductions for individuals’ out-of-pocket drug expenses. The initial version of the law, passed in 2012, contained a sunset provision for 2015. This date has been extended six times, including the most recent extension.
Massachusetts lawmakers are currently considering a bill to open up health screenings across the state. This bill, S 2567, would establish a statewide protocol for pharmacists to test or screen (and initiate treatment) for qualified health conditions, like influenza, COVID-19, and HIV. In effect, S 2567 would allow pharmacies to obtain CLIA waivers to expand on the types of health screening tests they currently offer. Then, it would allow pharmacists to administer, process, read and report the results, and treat conditions with appropriate therapies. S 2567 is in the early stages of its development and is expected to be heard by the House and Senate soon.
The state of Massachusetts ruled that all prescriptions for controlled substances and medical devices must be issued electronically, with only a few exceptions. ePrescribing allows for greater patient oversight from both physicians pharmacists and minimizes the risk of substance abuse. The law went into effect on January 1, 2021.