U.S. House Judiciary Committee Releases Scathing Report on CVS Health
The U.S. House Committee on the Judiciary and its Subcommittee on the Administrative State, Regulatory Reform, and Antitrust, released an interim staff report titled: “When CVS Writes the Rules: How CVS Protects Itself from Innovation and Competition”. The report outlines evidence that CVS Health [and CVS Caremark] engaged in a multi‑year strategy to suppress competition from emerging “hub pharmacies”—innovative digital platforms that streamline prescription access, price transparency, and patient support. These hubs partner with independent pharmacies to offer technology‑enabled services that challenge the vertically integrated CVS Health business model.
Internal documents showed CVS identified hub pharmacies as disruptive rivals capable of redefining the patient experience. CVS projected significant revenue risks if it failed to compete with these innovators and considered acquiring, partnering with, or building similar technology. The report argues that instead of innovating, CVS used its PBM market power to restrict independent pharmacies from working with hubs—through surveillance, provider manual changes, audits, and cease-and-desist letters—sometimes terminating pharmacies from its network.
Internal documents also showed that Plan Sponsors (e.g., employer groups) were driving audits to the pharmacy level when they noticed increases in drug spend and atypical spending patterns. Consequently, some pharmacies faced aggressive audits and/or were removed from employer networks.
The report argues CVS leveraged its vertically integrated structure to stifle competition from hubs, harming innovation and consumer choice. The Committee’s findings support both antitrust scrutiny and legislative intervention. Following congressional investigation, CVS made significant changes to its 2026 CVS Caremark Provider Manual, see Notable Updates From the 2026 Caremark Provider Manual in this month’s Newsline.
As a result of relaxed constraints, more independent pharmacies may be exploring pharmaceutical hub relationships. Opportunities to grow your business and/or enhance the patient experience certainly can help the bottom line. A few items to consider when working with hubs:
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Did you know there is much more to your audit assistance membership than just help with audits? The PAAS Member Portal contains a wealth of information and resources to assist you with audits and member service questions. Below is a list of 6 pages found on the Audit Assistance section of the PAAS Member Portal to assist you and your pharmacy staff to be proactive when it comes to audits.
- Access Services
- Audit Documentation Submission Guidance
- An online form to submit safe filling and billing questions
- Your PAAS Membership Manual
- Newsline
- Monthly newsletter articles, written by our expert PAAS analyst team, provide safe filling and billing tips and relays relevant/current PBM trends to be help prevent audits
- Search the Newsline Archive to get PAAS tips at the click of a button
- Special Edition Newslines including: Top 10 articles of the prior year, DMEPOS Article Series and a Self-Audit Article Series
- Ability to print monthly issues or individual articles
- Proactive Tips
- Audit flags – list of various claim attributes the PBMs use to select claims for audit
- Billing insulin vials – flowchart to assist whether you should bill Medicare Part B vs Part D
- DAW Codes Explained – use to understand when to effectively use DAW codes, their definitions and why claims may be flagged for audit if a DAW code is used incorrectly
- Basic DMEPOS documentation guidance
- Onsite Credentialing Checklist and expanded definitions of policies and procedures
- Proof of refill request and affirmative response form for DMEPOS items
- Steps on how to prepare for an onsite audit
- And more!
- Days’ Supply Charts
- Utilize the days’ supply charts for inhalers, insulins, nasal sprays, eye drops and topicals to aid you in calculating the correct days’ supply
- Guidance on overbilled quantities and incorrect days’ supply account for a sizable portion of audit chargebacks
- Additional miscellaneous charts, which include: Dispense in Original Container and Return to Stock
- Forms
- Signature Logbook for print
- Signature Trifold Mailer
- Fax and Email Coversheet
- Patient Attestation for over-the-counter COVID-19 test kits
- On-Demand Webinars
- Short webinars on hot topics in the PBM industry. Here are a few examples:
- USP 800 Compliance
- Cultural Competency Training
- Dispensing Prescriptions Off-Label
- Biologic Medications and Interchangeability
- Continuous Glucose Monitor Requirements for Medicare Part B
PAAS Tips:
- MORE AUDITS, MORE INSIGHT – PAAS National® is the industry-leading defender of community pharmacy dealings with Prescription Benefit Programs, including Caremark, Express Scripts, Humana, Medicaid, OptumRx, Prime Therapeutics., and more. PAAS assists on all third-party audits, including: desktop audits, onsite audits, invoice audits, OIG/Medicaid audits, Medicare B audits. The PAAS team is dedicated to helping you! We have five pharmacists and a complement of technician analysts with over 50 years of dedicated audit assistance experience. PAAS continuously updates their database with every audit received — in fact, we even keep a scorecard on individual auditors.
- Get answers to your questions on days’ supply calculations, drug substitutions, billing practices, required documentation, prior authorization requirements, record retention, and internal audit procedures – just to name a few. As a trusted partner, we will provide tailored guidance to help you proactively prevent audits. Remember, the prescription claims you submit today are the audits of the future.
- Keep your employees engaged and help lower audit risk by adding all employees to the portal and giving them permission to access these tools, resources and eNewsline. For more information review September 2019 Newsline article, What Are You Waiting For? Make Sure ALL of Your Employees are Added to the PAAS Portal!
- Contact PAAS at (608) 873-1342, if you would like a tour of your PAAS Member Portal, so you can reap all the benefits of your PAAS Audit Assistance. We appreciate you being a member.
