The Oklahoma Attorney General’s Office announced a $5.08 million settlement with CVS Caremark resolving allegations that the pharmacy benefit manager (PBM) violated state laws by reimbursing Oklahoma pharmacies below their acquisition cost for tens of thousands of prescriptions. The agreement, released December 8, 2025, provides restitution for 68,099 claims filled between January 2024 and August 2025.
According to Attorney General Gentner Drummond, Caremark’s reimbursement practices violated Oklahoma statutes governing PBMs, including provisions requiring fair-market reimbursement, timely responses to pharmacy payment disputes, and prohibition on payments below a pharmacy’s actual acquisition cost. See 59 O.S. § 360 (A)(4) and (A)(5). Specifically, Oklahoma law requires PBMs to respond to dispute submissions within 10 calendar days and to evaluate pricing disputes using national drug-pricing benchmarks and pharmacy-supplied cost documentation. The Attorney General alleged that Caremark repeatedly failed to comply with these requirements.
Under the settlement, Caremark will pay more than $5 million in restitution and penalties, with 75 percent going directly to affected pharmacies and the balance funding ongoing PBM oversight. The agreement also mandates operational reforms to Caremark’s reimbursement and dispute-resolution practices, including requirements to (1) evaluate pharmacy challenges against national pricing benchmarks, (2) accept documentation of actual acquisition costs, and (3) comply with statutory deadlines when resolving disputes.
The settlement also mandates that Caremark must also work with the Attorney General’s PBM Compliance and Enforcement Unit for 90 days to address any ongoing complaints.
While Caremark did not specifically admit to any wrongdoing in the settlement, the enforcement action stems from an earlier state lawsuit alleging that Caremark reimbursed multiple Oklahoma pharmacies at rates “well below their acquisition cost,” threatening the financial viability of rural and independent pharmacies. The Attorney General’s Office has prioritized PBM oversight following legislative reforms that strengthened state authority over PBM conduct, including enforcement powers under Oklahoma’s Pharmacy Benefit Manager Act (Title 36) and related insurance-regulation provisions.
The settlement is the second major enforcement action the state has taken against Caremark in the latter half of 2025. In September, the Attorney General secured a separate $32 million settlement over allegations that Caremark improperly retained drug-manufacturer rebates owed to HealthChoice, the state employee health plan. See Frier Levitt’s prior article discussing this $32 Million Settlement.
Attorney General Drummond said in a statement announcing the settlement that the latest agreement protects patients’ “access to the prescriptions [they] need and the pharmacists [they] trust, especially in small towns where the local pharmacy is often the only option for healthcare.” Where retail pharmacies often operate on razor-thin margins, settlement agreements that result in money being infused directly into retail pharmacies is essential to helping these pharmacies stay operational. Attorney General Drummond’s Office is likely to continue its active enforcement against PBMs to ensure compliance with Oklahoma law and protect pharmacy access across the state.
How Frier Levitt Can Help Pharmacies with PBM Issues
Frier Levitt provides comprehensive legal representation to pharmacies across the country in matters involving PBM reimbursement, audits, and network participation. We are dedicated to protecting the rights of pharmacies and guiding them through complex regulatory challenges and audit responses. If your pharmacy has been under-reimbursed by a PBM or is having PBM network or payment disputes, Frier Levitt’s experienced attorneys are available to provide informed guidance and effective advocacy. Contact us today if you believe PBMs are failing to abide by their provider agreements or state regulations.
