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Hospitals sue CVS Health over alleged $250M 340B spread-pricing scheme

Published
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10

Why it matters

Three major health systems have filed separate lawsuits against CVS Health and its pharmacy benefit manager, CVS Caremark, alleging the companies diverted approximately $250 million in savings from the federal 340B Drug Pricing Program between 2020 and 2025. Mount Sinai Health System, University of Michigan Health, and University of Kansas Health System are the plaintiffs. The core allegation centers on CVS's "spread pricing" model: insurers paid CVS at full network rates while CVS allegedly reimbursed 340B-eligible hospitals at lower rates and retained the difference. The suits also name CVS pharmacy subsidiaries and focus on CVS's third-party administrator, which allegedly identified claims as 340B-eligible weeks after dispensing and after insurers had already reimbursed CVS in full.

The 340B program requires drug manufacturers to sell outpatient medications at discounted prices to eligible hospitals and clinics, enabling those institutions to stretch resources for low-income and uninsured patients. The hospitals contend that CVS's reimbursement structure captured these manufacturer discounts as corporate profit rather than allowing the savings to reach patient care—effectively converting the program's intended benefit into revenue for the pharmacy chain.

Attorneys tracking pharmacy benefit manager disputes should monitor these cases closely. The lawsuits target a major PBM on a substantial dollar figure and involve prominent academic health systems with resources to litigate. The spread pricing model alleged here—capturing 340B discounts through timing and reimbursement mechanics—may signal broader industry practices now facing legal scrutiny. CVS has declined to comment pending litigation.

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