CVS Lawsuit: False Claims Judgments, Opioid Cases, and PBM Suits

CVS Health is facing an unusually broad wave of lawsuits, and the CVS lawsuits currently in play span nearly every part of its business: nearly $1.24 billion in False Claims Act judgments against its Omnicare and Caremark subsidiaries, a Department of Justice case accusing it of fueling the opioid crisis, a RICO class action over pharmacy benefit manager rebates, hospital suits over 340B drug pricing, consumer class actions over recalled eye drops and PFAS in bandages, and a constitutional challenge that CVS itself filed against Tennessee. Several of these matters hit major milestones in 2025 and 2026.

The Two Largest Judgments: Nearly $1.24 Billion in False Claims Act Cases

Two separate federal courts entered massive False Claims Act judgments against CVS subsidiaries within weeks of each other in the summer of 2025.

Omnicare: $948.8 Million Over Invalid Prescriptions

A federal jury in the Southern District of New York found that Omnicare, CVS’s long-term care pharmacy, had fraudulently billed Medicare, Medicaid, and TRICARE for prescriptions that were never properly renewed. According to the government, Omnicare “rolled over” expired prescriptions by assigning new prescription numbers without getting fresh authorizations from physicians, then continued dispensing medications to residents of assisted-living facilities and group homes for months or years. The scheme allegedly produced more than 3.3 million false claims between 2010 and 2018.¹²

The jury awarded $135.6 million in actual damages. The court trebled that to $406.8 million under the False Claims Act and added $542 million in civil penalties, bringing the total to $948.8 million when judgment was entered on July 7, 2025.³ The whistleblower was Uri Bassan, a former Omnicare pharmacist in Albuquerque. CVS says it will appeal.¹

Caremark: $290 Million Over Inflated Medicare Drug Prices

On August 19, 2025, Judge Mitchell S. Goldberg of the Eastern District of Pennsylvania entered a final judgment of roughly $290 million against CVS Caremark. After a bench trial, the court found that Caremark had inflated the drug prices it reported to Medicare, causing the program to overpay by about $95 million. The court trebled that to $285 million and added $4.9 million in civil penalties.³

The whistleblower, Sarah Behnke, was an actuary at Aetna. She alleged Caremark charged Medicare Part D more for drugs than it charged its commercial clients. The judge rejected CVS’s arguments that the award violated the Eighth Amendment’s excessive fines clause and the Due Process Clause.⁴ CVS has appealed.⁵

DOJ Case Alleging CVS Fueled the Opioid Crisis

On December 18, 2024, the Department of Justice unsealed a nationwide civil suit accusing CVS of dispensing controlled substances in violation of the Controlled Substances Act and then billing federal healthcare programs for those prescriptions, violating the False Claims Act. The case, filed in the District of Rhode Island (No. 1:22-cv-222), started as a whistleblower complaint by former CVS employee Hillary Estright in October 2019.⁶

The complaint alleges that from October 2013 onward, CVS pharmacists routinely filled prescriptions from suspected pill mills, dispensed excessive quantities of opioids, approved early refills, and filled so-called “trinity” prescriptions combining an opioid, a benzodiazepine, and a muscle relaxant. The government says CVS’s own performance metrics, which prioritized speed and volume, discouraged pharmacists from investigating red flags, and that low staffing produced what the complaint calls an “assembly-line style of medication preparation.” The complaint also alleges CVS rejected a due diligence checklist for high-risk opioid prescriptions after estimating it would cost $11 million in additional labor.⁷⁸

CVS says it “strongly disagrees” with the allegations. The case is active, and no determination of liability has been made.⁶

Two More False Claims Act Settlements in 2025

Alongside the trial judgments, CVS resolved two other federal fraud matters through payment in late 2025.

On December 2, 2025, the U.S. Attorney’s Office for the Southern District of New York announced a $37.76 million settlement covering insulin pen dispensing between 2010 and 2020. CVS admitted dispensing more insulin pens than patients needed, refilling prescriptions before they were due, and under-reporting the “days-of-supply” figure to bypass PBM controls designed to catch premature refills. About $24.4 million went to the federal government, with the rest going to states. The settlement resolved five whistleblower cases that had been filed under seal.⁹

Two weeks earlier, on November 17, 2025, CVS paid $18.2 million to the United States and California to resolve allegations that it billed Medi-Cal for “Code 1” drugs, which carry restricted reimbursement tied to specific diagnoses, without confirming the required diagnoses. The government said CVS sometimes filled the prescriptions for non-approved conditions and used false electronic certifications from 2010 through 2021. A former CVS pharmacist brought the case and received approximately $3.3 million.¹⁰¹¹

Pharmacy Benefit Manager Suits and Investigations

CVS Caremark, the pharmacy benefit manager arm, is under pressure from private plaintiffs, federal regulators, and state attorneys general.

Roofers’ Union RICO Class Action

On March 18, 2026, the Roofers’ Union Welfare Trust Fund filed a class action in the District of Rhode Island (No. 1:26-cv-00162) accusing CVS Caremark and its subsidiary Zinc Health Services of violating the Racketeer Influenced and Corrupt Organizations Act. The suit alleges that since at least 2020, CVS used Zinc as a “smokescreen” to collect billions from drug manufacturers in exchange for favorable placement on the Caremark formulary, labeling those payments as “bona fide service” fees to avoid contractual obligations to pass rebates through to clients. The complaint argues that this drove up costs by prioritizing expensive brand-name drugs over cheaper generics. CVS has said it passes through more than 99% of all rebates and manufacturer fees to clients.¹²¹³

FTC Investigation and Congressional Findings

In February 2025, a federal court in the District of Columbia ordered CVS Caremark to comply with an FTC civil investigative demand originally issued in December 2023, requiring production of documents about its pharmacy management practices.¹⁴

An FTC interim staff report from January 2025 found that Caremark, Express Scripts, and Optum Rx marked up specialty generic drugs at their affiliated pharmacies, producing $7.3 billion in additional revenue between 2017 and 2022, and reimbursed their own pharmacies at higher rates than unaffiliated ones for nearly every specialty generic drug analyzed.¹⁵ In January 2026, the House Judiciary Committee released a report concluding that “it is possible that CVS Health’s conduct violated the antitrust laws,” citing evidence that CVS used pharmacy network contracts to block independent pharmacies from third-party specialty medication services.¹⁶

State Attorney General Actions

Oklahoma Attorney General Gentner Drummond filed an administrative action in January 2025, citing roughly 200 instances of CVS reimbursing pharmacies below the actual acquisition cost of medications. By December 2025, Oklahoma reached a $5.08 million settlement covering 68,099 prescriptions, with 75% of fines going to affected pharmacies. CVS denied wrongdoing.¹⁷¹⁸

Vermont Attorney General Charity Clark filed a broader case in July 2024 against CVS and Evernorth (owner of Express Scripts), alleging the PBMs “distorted the market” by steering formulary placement toward drugs with the highest manufacturer payments while restricting cheaper alternatives.¹⁹

Hospital Lawsuits Over 340B Drug Pricing

In May 2026, three major health systems filed separate federal suits accusing CVS of a “secret pricing scheme” that diverted roughly $250 million in 340B Drug Pricing Program savings between 2020 and 2025. The plaintiffs are Mount Sinai Health System, Michigan Medicine, and the University of Kansas Health System.²⁰

The lawsuits allege that because 340B eligibility for specialty drugs is often set after the point of sale, claims are first processed at standard rates. CVS’s subsidiary WellPartner later flags claims as 340B-eligible, at which point CaremarkPCS pays CVS Specialty an artificially reduced reimbursement. WellPartner then presents that reduced amount to hospitals as the full reimbursement, with CVS keeping the difference. The University of Kansas Health System also alleges CVS refused a contractually required audit and then terminated its 340B agreement. CVS has declined to comment.²¹

CVS’s Own Suit Against Tennessee’s PBM Ownership Ban

CVS isn’t only defending. On May 22, 2026, it filed a 56-page complaint in the Middle District of Tennessee challenging the constitutionality of the state’s “Freedom, Access and Integrity in Registered Pharmacy” (FAIR Rx) Act. Signed by Governor Bill Lee, the law bans pharmacy benefit managers from owning pharmacies, with a compliance deadline of July 2028.²²

CVS argues the law violates the Commerce Clause by discriminating against out-of-state businesses to protect local independent pharmacies, and that ERISA preempts it by interfering with nationwide employee benefit plans. CVS says compliance would force it to close 136 retail and specialty pharmacies, shutter 25 medical clinics, and lay off about 2,000 employees in Tennessee. Supporters of the law, including the Tennessee Pharmacists Association, cite a state audit finding that PBMs were reimbursing their own affiliated pharmacies at rates up to 160 times higher than unaffiliated ones.²³

CVS is leaning on a recent precedent: in July 2025, U.S. District Judge Brian Miller blocked a similar Arkansas ban, finding it likely violated the Commerce Clause and was preempted by the federal TRICARE program. Arkansas has appealed.²⁴

Opioid Cases Beyond the DOJ Suit

CVS reached a $484 million opioid settlement with Florida in March 2022 and has agreed to pay up to $130.3 million over ten years to federally recognized Native American tribes. Under the tribal settlement, 85% of funds must go toward opioid abatement.²⁵

Not every opioid case has gone against CVS. In May 2026, a Broward County judge ruled for CVS, Walgreens, and Walmart in a lawsuit brought by 16 Florida hospitals seeking $528.3 million in direct opioid treatment costs and $1.5 billion in related care. An earlier jury trial in late 2025 ended in a mistrial. The judge then ruled that the hospitals failed to prove their losses were directly caused by the pharmacies, finding the harm was only “indirect.”²⁶

Consumer Class Actions

Recalled Eye Drops

CVS agreed to a settlement of up to $1 million (some sources report a $10 million fund) to resolve a class action over CVS store-brand eye drops recalled after the FDA found unsanitary conditions at an Indian manufacturing facility. Ruffin v. CVS Pharmacy Inc. (No. 7:23-cv-01660, E.D.N.C.) covers nine CVS-brand eye drop products purchased between October 1, 2021, and October 25, 2023. A final approval hearing was scheduled for August 2025.²⁷²⁸

PFAS in Bandages

In October 2024, a class action in the Northern District of California (Bourne v. CVS Health Corporation, No. 3:24-cv-06899) alleged that CVS Health-brand bandages contain undisclosed per- and polyfluoroalkyl substances, or “forever chemicals.” The suit says CVS marketed the bandages as sterile and antibacterial while failing to disclose PFAS, which are linked to cancer and other health problems. A similar PFAS-in-bandages case against a different manufacturer was dismissed in February 2026 for lack of standing, which could affect this case.²⁹³⁰

California Non-Compete

In February 2025, a registered nurse filed a proposed class action (Hall v. CVS Health Corporation, No. 1:25-cv-00173) alleging that CVS’s “Restricted Covenant Agreement” violates California labor law. It challenges four provisions: a 12-month non-compete, a customer non-solicitation clause, an employee non-solicitation clause, and an inventions assignment clause the plaintiff says forces employees to hand over intellectual property created on their own time.³¹

Other Notable Pending Matters

Zepbound formulary exclusion. CVS Caremark’s 2025 decision to drop Zepbound (tirzepatide) from its standard formularies in favor of Wegovy has produced ERISA suits from plan participants. In Larkin v. Caremark RX, pending in the Southern District of New York, plaintiffs allege the denial was “arbitrary and capricious” because the two drugs have different active ingredients and are not interchangeable. A related case, Hamburger v. Caremark RX, is pending in the District of Columbia. CVS says the suits are “without merit” and that a case-by-case exceptions process exists.³²

Aetna acquisition securities case. Former Aetna shareholders sued CVS in 2019 over allegedly misleading statements about a $6 billion goodwill asset tied to CVS’s 2015 Omnicare purchase. CVS later recorded goodwill impairments of $3.9 billion in Q2 2018 and $2.2 billion in Q4. U.S. District Judge Mary S. McElroy dismissed the amended complaint in February 2025. The lead plaintiff appealed to the First Circuit, which heard oral argument on January 6, 2026. A ruling is pending.³³³⁴

Louisiana patient data suit. Two Louisiana law firms filed a class action after CVS Caremark sent mass texts and emails to customers urging them to oppose House Bill 358, which would have barred PBMs from owning pharmacies in the state. Louisiana Attorney General Liz Murrill also issued a cease-and-desist order and opened an investigation into whether CVS “improperly appropriated” personal information of state employee health plan members. CVS says its communications were “consistent with law.”³⁵

Wage-and-hour history. CVS has incurred more than $108 million in wage and hour penalties across 69 recorded cases since 2000. Notable settlements include $34 million in 2012 for assistant store managers over unpaid overtime, $15 million in 2014 for call center employees required to log in before paid shifts began, and roughly $3 million for pharmacists over unpaid overtime for working six consecutive days.³⁶

1
Reuters. Judge Orders CVS Omnicare Unit to Pay $949 Million Over Invalid Prescriptions
2
McKnight’s Senior Living. Long-Term Care Pharmacy Omnicare Says It Will Appeal One of the Largest Damages Verdicts in False Claims Act Case
3
American Bar Association. CVS Takes Second FCA Punch
4
Duane Morris. Pharmacy Benefit Manager Ordered to Pay $290 Million for Medicare Overbilling
5
Legal Newsline. CVS Caremark Appeals $290M Decision in Whistleblower’s Case
6
U.S. Department of Justice. Justice Department Files Nationwide Lawsuit Alleging CVS Knowingly Dispensed Controlled Substances
7
CNN. DOJ CVS Opioid Lawsuit
8
U.S. Department of Justice. United States of America ex rel. Estright v. CVS Pharmacy, Consolidated Complaint in Intervention
9
U.S. Department of Justice. U.S. Attorney Announces $37.76 Million Settlement With CVS Over Dispensing Insulin Pens
10
U.S. Department of Justice. CVS Pharmacy Inc. Pays $18.2 Million to Resolve Alleged False Claims Act Violations
11
California Office of the Attorney General. Attorney General Bonta, U.S. DOJ Secure $18.2 Million Settlement With CVS
12
ClassAction.org. Class Action Lawsuit Claims CVS Caremark Sold Drug Formulary Access, Retained Health Plan Rebates
13
Federal Trade Commission. CVS Answer to FTC Complaint
14
National Community Pharmacists Association. Federal Court Orders CVS Caremark Comply Antitrust Investigation
15
Healthcare Dive. FTC Releases Second Interim Staff Report on Prescription Drug Middlemen
16
House Judiciary Committee. House Panel Finds CVS Caremark May Have Broken Antitrust Laws
17
Oklahoma Voice. Oklahoma Attorney General Files Lawsuit Against CVS Caremark for Below-Cost Reimbursement
18
Oklahoma Attorney General. Drummond Holds CVS Caremark Accountable With $5M Settlement
19
Vermont Attorney General. Attorney General Clark Sues Pharmacy Benefit Managers Illegally Driving Prescription Drug Costs
20
Healthcare Dive. Hospitals File 340B Lawsuit Against CVS Health
21
Becker’s Payer. Health Systems Sue CVS Over Alleged $250M 340B Scheme
22
Healthcare Dive. CVS Lawsuit Against Tennessee PBM Pharmacy Ownership Law
23
Tennessee Lookout. CVS Sues Tennessee Over Pharmacy Benefit Manager Monopoly Law
24
Arkansas Advocate. Federal Judge Blocks Arkansas Restrictions on Pharmacy Benefit Managers
25
Tribal Opioid Settlements. CVS Tribal Opioid Settlement
26
Reuters. CVS, Walgreens, Walmart Defeat Florida Hospitals Opioid Lawsuit
27
ClassAction.org. Up to $1M CVS Settlement Ends Class Action Lawsuit Over Recalled Eye Drops
28
CVS Eye Drop Settlement. CVS Eye Drop Settlement Official Website
29
ClassAction.org. CVS Lawsuit Alleges Bandages Contain Dangerous Forever Chemicals
30
ClassAction.org. Bourne v. CVS Health Corporation, Complaint
31
ClassAction.org. CVS Lawsuit Claims Non-Compete Clause in Employment Agreement Violates California Labor Law
32
HCCA. Compliance Today – CVS Caremark Formulary Litigation
33
Court Listener. In Re CVS Health Corp. Securities Act Litigation, Oral Argument
34
Stanford Securities Class Action Clearinghouse. CVS Health Corporation Securities Litigation
35
WDSU. Louisiana CVS Class Action Lawsuit
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Violation Tracker. CVS Health Violation Tracker