By Michel Daher
Let me break this down more clearly. In the realm of long-term care, unlike the usual trip many of us might make to a pharmacy for medication, long-term care pharmacies handle things differently. They provide medications in bubble packs, salad packs, or baggies and deliver them directly to places like retirement homes, assisted living, board and care homes, or skilled nursing facilities. Typically, when visiting a doctor, a patient might receive a prescription, sometimes with refills or none at all. This is true for patients in these care facilities as well—doctors may prescribe up to a year’s worth of refills or opt for no refills at all. Omnicare, however, was found to have unlawfully bypassed doctors by adding refills to prescriptions to fraudulently bill for claims and send out medications.
The case against Omnicare was brought to light by pharmacist Uri Bassan, who became a whistleblower and filed a lawsuit on behalf of the government and 29 states back in 2015. CVS Omnicare serves some of the largest assisted living facilities nationwide, including those affiliated with Brookdale Senior Living, Atria Senior Living, and Oakmont Senior Living. It’s important to note that because Omnicare is linked to a pharmacy benefit manager (PBM), it secured higher reimbursements for itself compared to independent pharmacies. The lawsuit claimed that Omnicare forged prescriptions impacting patients in 1,766 facilities between 2010 and 2018. Had this been a smaller, independent pharmacy or private entity, severe penalties or jail time would likely have followed.
Recently, Gov. Sarah Huckabee signed Arkansas Act 624, effectively banning PBMs from running pharmacies in the state. CVS stated that this would necessitate the closure of their 23 locations in Arkansas by January 1, 2026, and has since filed a lawsuit against the state, arguing that the law is unconstitutional. CVS asserts that shutting down these stores would negatively impact patients, limit access to medications, raise prescription costs, and lead to about 500 job losses. However, Arkansas has 734 licensed pharmacy operators in total, so CVS’s exit might not be as drastic as they claim. Given these developments, the era of PBMs may be waning, which could be beneficial for both patients and independent pharmacies.
