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CVS Caremark, one of the largest pharmacy benefit managers in the country, agreed to pay at least $45 million to the state of Illinois to settle allegations that rebates were not passed through during a recent four-year period, according to a document obtained by STAT.

At issue is a complicated, behind-the-scenes relationship between the PBM and several related entities — in particular, a so-called group purchasing organization — that allegedly obscured rebates paid by drug manufacturers but that should have been sent on to the state. This arrangement was noted in a contract that began in 2015 with the Illinois Department of Central Management Services.

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Illinois Attorney General Kwame Raoul began investigating CVS Caremark over concerns that rebates were not being passed back to the state, according to a June 24, 2024, settlement agreement between the state and the PBM. He also maintained that the PBM did not adequately disclose to the state the nature of the relationships with the other CVS entities.

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