CVS agreed to pay $315 million to resolve allegations that it illegally filled opioid prescriptions and sought federal health care payment.

The main point: The settlement resolves allegations that, from 2013 through 2025, CVS:

1. Illegally filled prescriptions for opioids and other controlled substances in violation of the Controlled Substances Act
2. Sought payment for many of those invalid prescriptions from Medicare and other federal health care programs in violation of the False Claims Act

The details:

• The federal government’s complaint alleged that CVS knowingly filled prescriptions for controlled substances that lacked a legitimate medical purpose, were not valid, and/or were not issued in the usual course of professional practice, despite clear red flags. That includes prescriptions for excessive quantities of opioids, opioid prescriptions filled too early, combinations of opioids, benzodiazepines, and muscle relaxants, and prescriptions from “pill mill” prescribers.
• It alleged that the violations stemmed from corporate-imposed performance metrics, incentive compensation, and staffing policies that prioritized profits over patient safety. That includes failing to employ enough pharmacists to serve patients, comply with legal obligations, and meet corporate performance metrics. It also includes policies that allegedly prevented pharmacists from warning one another about certain problematic prescribers.

What’s coming: In addition to the $315 million payment, CVS is required to establish a hotline for employees and the public to report suspected illegal dispensing of controlled substances, proactively monitor pharmacy dispensing patterns, and establish a process to evaluate prescribers suspected of illegal prescribing.