breakingnews surfky 300 cFRANKFORT, Ky. (7/9/18) — The Kentucky Department of Insurance issued an Order of Civil Penalty and Probation against pharmacy benefit manager CaremarkPCS Health for multiple violations of the Kentucky Insurance Code.

As a result, Caremark’s pharmacy benefit manager license has been placed on probation for 12 months and Caremark has been assessed a fine of $1,551,500.

The Order cites 454 violations related to reimbursement claim denials issued to pharmacists across the Commonwealth of Kentucky, an additional 38 violations where Caremark provided inaccurate or inconsistent information to the Department, and 454 violations of the Unfair Claims Settlement Practices Act for procedural violations in each pharmacy claim.

“The Department simply does not issue penalties of this nature lightly,” says Patrick D. O’Connor II, Deputy Commissioner for Policy. “However, we have to ensure companies fully comply with our laws to protect consumers and other businesses.”

Kentucky pharmacists can submit complaints to the Department for various issues, including whether the PBM’s reimbursement and appeal determination meet certain requirements.  The Department’s Consumer Protection Division reviews and investigates each pharmacy complaint to evaluate the PBM’s compliance with Kentucky law.

The 454 violations related to pharmacy reimbursement claim denials stem from requirements established by the 2016 General Assembly and a Department regulation promulgated with the input of various interested parties. 

During the Department’s review of each of the 454 claims individually submitted by Kentucky pharmacists, the Department identified discrepancies between Caremark’s pricing statements initially made to pharmacists and those subsequently provided in response to Department requests. On 38 occasions, Caremark provided conflicting pricing information to the Department in multiple requests for the same claim.

CaremarkPCS Health, LLC, a subsidiary of CVS Caremark, is one of two CVS Caremark subsidiaries licensed to operate as a pharmacy benefit manager in Kentucky by the Department.

The Kentucky Department of Insurance regulates the Commonwealth’s insurance market, licenses agents and other insurance professionals, including pharmacy benefit managers, monitors the financial condition of companies, educates consumers on available insurance options, and ensures Kentuckians are treated fairly in the marketplace. To learn more about DOI, visit http://insurance.ky.gov/.

SurfKY News

sitelogosm© Copyright 2008 - 2018 SurfKY News Group, Inc. All rights reserved.
This material may not be published, broadcast, or rewritten without permission.

Click here to subscribe to receive daily updates by email.

Most Read This Week...

Sep 17, 2018 6436

Muhlenberg Grand Jury Indictments Handed Down

by SurfKY News
Sep 18, 2018 5677

Teens Injured after Vehicle Accident Near Mortons Gap

by Ladonna Kay Lee
Sep 16, 2018 5259

UPDATE: Ky. 181S Accident Victim Uninjured

by Paul Moore
Sep 18, 2018 5178

Madisonville City Council Debates Public Street Closure for LGBT Event

by Doreen Dennis, SurfKY News
Sep 18, 2018 3433

Arrest Made in Alleged Area Burglaries

by Rita Dukes Smith, SurfKY News Director
Sep 16, 2018 3356

Daviess County D-League Combine Set for Sept. 24

by Steve LeMaster
Sep 17, 2018 2438

Pursuit in Hopkinsville Ends in Suspect's Death

by Doreen Dennis, SurfKY News
Sep 17, 2018 1520

UPDATE: U.S. 68 Bypass at Pennyrile Exit 6 Reopen after Crash

by Doreen Dennis, SurfKY News
Sep 16, 2018 1224

DAVE SAYS: Don't Make Rash Decision about Job

by SurfKY News
Sep 16, 2018 1213

OUTDOOR TRUTHS: Most Valuable Things Close to Home

by SurfKY News

Most Read This Month

Sep 10, 2018 14385

Fight in Rural King Results in Madisonville Man's Arrest

by Doreen Dennis, SurfKY News
Sep 03, 2018 13977

UPDATE: Pedestrian Struck by Train in Henderson Dies of Injuries

by Nick Risley, SurfKY News

 

Weather brought to you by

90°
32°
°F | °C
Mostly Sunny
Humidity: 48%
Tue
Scattered Thunderstorms
69 | 93
20 | 33
Wed
Thunderstorms
69 | 94
20 | 34
Thu
Sunny
72 | 95
22 | 35
Fri
Thunderstorms
72 | 90
22 | 32

Stories Trending Today

Mortons Gap 9 18
Sep 18, 2018 5677

Teens Injured after Vehicle Accident Near Mortons Gap

by Ladonna Kay Lee
IMG 0471
Sep 18, 2018 5259

UPDATE: Ky. 181S Accident Victim Uninjured

by Paul Moore
cityhall1 300
Sep 18, 2018 5178

Madisonville City Council Debates Public Street Closure for LGBT Event

by Doreen Dennis, SurfKY News
fleming arrest
Sep 18, 2018 3433

Arrest Made in Alleged Area Burglaries

by Rita Dukes Smith, SurfKY News Director

Market Report

Market Report brought to you by