In a move aimed at protecting the interests of taxpayers and ensuring fair drug pricing practices, Massachusetts Attorney General Andrea Joy Campbell has stepped into the legal fray against CVS Health Corporation and CVS Pharmacy, Inc. The suit accuses the mega-pharmacy chain of shortchanging MassHealth—the state's Medicaid program—by neglecting to offer them the same low drug prices available to some cash-paying customers.

It's a straightforward allegation: CVS, through a discount program managed by ScriptSave, reportedly cut deals for prescription medicine that weren't extended to MassHealth, contrary to state regulations. These rules are clear in their directive; pharmacies must charge MassHealth the lowest price afforded to any other customer, a point highlighted by AG Campbell in her complaint, "When pharmacies offer discounted drug pricing to its customers, they must also charge MassHealth that same low price," she said, in a statement obtained by Mass.gov . According to the Attorney General's office, MassHealth has been entitled to a "Most Favored Nation" drug pricing clause since 1995, which seemingly was not honored, particularly for generic drugs.

The case at hand is not solely a Massachusetts matter, joining forces are the attorneys general from Connecticut, Indiana, and Oklahoma, in concert with AG Campbell. What initiated this multi-state legal challenge was a whistleblower's earlier complaint filed in the United States District Court for the District of Columbia, which put the spotlight on CVS's alleged non-compliant billing practices.

The AG's Medicaid Fraud Division, annually backed by the U.S. Department of Health and Human Services, spearheads this charge. Besides prosecuting fraudsters in the healthcare arena, they hold jurisdiction over cases pertaining to abuse, neglect, and financial exploitation within long-term care facilities and against Medicaid patients more broadly. In fiscal year 2025, a federal grant showered the Massachusetts Medicaid Fraud Division with $5,922,320, 75 percent of its funding, while the Commonwealth of Massachusetts supplemented the remaining 25 percent or $1,974,102.

Concerned citizens can flag MassHealth fraud or report abuse and neglect of Medicaid patients or long-term care residents via the AGO's website.