Case Result: Pain Management Specialist Wins CVS Court Case After Being Cut Off from Prescription Fills

Professional: 
Pain Management Specialist

Venue:
U.S. District Court, Eastern District of Kentucky, Covington Division

Name of Case:
Hansen et al v. CVS Pharmacy, Inc., 2:21-cv-00092

Primary Issue:
Client is a certified, licensed pain management specialist who runs an interventional pain management practice in Northern Kentucky. His meticulous compliance policy for prescribing controlled substances includes closely monitoring patients to spot signs of “doctor shopping” and drug diversion, via urine screening and the state automated prescription reporting system.

He received a call in June 2021 from a CVS corporate office representative, who asked questions about client’s practice and his procedures for prescribing. Client did not get any sort of indication from the CVS representative that any of his prescriptions were suspect, and none of his past prescriptions had been questioned or denied by third-party payors or CVS for being medically unnecessary.

On July 28, 2021, client received a letter from CVS that stated its pharmacy locations would no longer fill his legitimate, medically necessary prescriptions, with no reason provided for the exclusion.

Argument:
Our white collar and government investigations defense lawyers cited the “drug monitoring program,” which CVS implemented in 2012, as the main reason for CVS’s decision to cut off client’s prescriptions. We contended that CVS’s system “uses algorithms to gather aggregate data on physician prescribing practices to identify physicians who demonstrate extreme patterns of prescribing certain highly regulated drugs.”

However, we noted that client did not undergo an investigation prior to being excluded from prescriptions. CVS did not review charts or medical records, pharmacy profiles, or individual patient data; did not contact any of client’s patients about their prescriptions; did not commence an inspection of client’s practice; and did not cite any of his prescriptions as illicit.

Further, in citing tortious interference with a contractual relationship and tortious interference with a business relationship, our attorneys asserted that client’s reputation and practice will suffer. Client’s practice will have an unjustified stigma attached to it, prompting other pharmacies to also cut off his prescriptions, “for fear of regulatory scrutiny,” and “blanket refusal” to fill his prescriptions will lead to business loss and “inadequate treatment to its patient population.”

Result:
A federal judge on August 10, 2021, granted a preliminary injunction on this case, preventing CVS from taking action in denying this prescriber’s prescriptions to be filled, until a trial is held on the issue. 

Areas of Law:
Drug Diversion
Unlawful Dispensing of a Controlled Substance

Disclaimer:
This information is a sample of our past results. Prospective clients may not obtain the same or similar results. Every case is different and each case must be evaluated and handled on its own merits. The circumstances of your case may differ from the results provided. The information provided has not been reviewed or approved by the State Bar.

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