Cornerstone Research has worked with counsel for several pharmaceutical companies on state False Claims Act cases alleging that these companies caused state Medicaid agencies to overpay for prescription drugs by posting fraudulent prices.
Cornerstone Research has worked with counsel for several pharmaceutical companies on state False Claims Act cases alleging that these companies caused state Medicaid agencies to overpay for prescription drugs by posting fraudulent prices. The allegations center on the reporting of average wholesale prices (AWPs) for branded and generic drugs that were sometimes used as the basis for reimbursing pharmacies for the prescription drug acquisition costs.
States’ attorneys general claimed that state Medicaid agencies’ reimbursements to pharmacies were inflated because pharmaceutical companies posted false and inflated AWPs.
Cornerstone Research has supported experts who responded to this claim. Our work demonstrated that AWPs were widely known to exceed pharmacy acquisition costs, that information on actual pharmacy acquisition costs was available to state Medicaid officials, and that state Medicaid officials took this information into account when setting reimbursement levels. We also showed that the plaintiffs’ “but-for” pharmacy reimbursement levels would have resulted in pharmacies losing money on prescriptions filled for Medicaid beneficiaries, potentially resulting in greatly reduced access to pharmacy services for Medicaid beneficiaries in violation of federal Medicaid requirements.