TL/DR –
CVS Pharmacy Inc. and its affiliated corporate entities have agreed to pay a settlement of $315 million to resolve allegations related to opioid prescriptions and claims. The complaint alleges that CVS illegally filled prescriptions for opioids and other controlled substances, often seeking payment for these invalid prescriptions via Medicare and other federal healthcare programs, violating the Controlled Substances Act and the False Claims Act. Besides the monetary settlement, CVS has also agreed to establish a hotline for reporting suspected illegal dispensing of controlled substances, monitor dispensing patterns proactively, and set up a process to evaluate prescribers suspected of illegal prescribing.
CVS to Pay $315 Million in Opioid Prescription Case Settlement
CVS Pharmacy Inc. and its subsidiary entities have agreed to a $315 million settlement to resolve allegations in an opioid prescriptions case, as announced by US Attorney Ken Sorenson. This settlement is tied to allegations that from Oct. 17, 2013 through Dec. 2, 2025, CVS illegally dispensed opioids in violation of the Controlled Substances Act and False Claims Act.
US Attorney Sorenson expressed the severity of large scale fraud in the healthcare system, emphasizing the commitment to protecting patients and the integrity of federal healthcare programs. This case illustrates the nationwide opioid epidemic that has affected communities across the country, including in Rhode Island where the case was filed.
CVS is alleged to have knowingly filled illegitimate prescriptions for controlled substances outside of professional practice norms. The unlawful prescriptions included dangerous and excessive quantities of opioids, prescriptions filled prematurely, and “trinity” prescriptions – a high-risk cocktail of opioids, a benzodiazepine, and a muscle relaxant. The pharmacy chain is also accused of dispensing prescriptions from “pill mill” prescribers, who issue large volumes of controlled substances without medical necessity.
The US alleges that CVS pharmacists overlooked red flags that indicated potential illegitimate prescriptions. Many of these prescriptions were consequently billed to and reimbursed by federal healthcare programs. The allegations further highlight that CVS’s violations stemmed from prioritizing corporate profits over patient safety due to corporate-imposed performance metrics and staffing policies.
In addition to the monetary settlement, CVS has committed to future obligations for dispensing controlled substances through a memorandum of agreement with the DEA. Measures include establishing a hotline for reporting suspected illegal dispensing, monitoring dispensing patterns, and implementing a process to evaluate potentially unlawful prescribing practices.
The settlement resolves a civil lawsuit brought under the False Claims Act by a former CVS employee, Hillary Estright, who is eligible to receive a share of the recovery once determined. The case is known as United States ex rel. Hillary Estright v. CVS Health Corporation, et al., No. 22-cv-00222 (D.R.I.).
It’s pertinent to note that the claims resolved by the settlement are allegations only, with no determination of liability.
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