Loyalty Strained at Caremark

Critics have long complained about a lack of transparency in the industry. They would like to know exactly how much PBMs pay and charge for their drugs. But the PBMs claim they are simply trying to protect trade secrets that help lower prescription-drug costs.

Roskam first began seeking information about Caremark's contract in Illinois late last year. Since then, news has surfaced that the state's top law enforcement official -- Attorney General Lisa Madigan -- is raising questions about the company's "returned goods" practices.

In the Florida case, former Caremark pharmacists Michael and Peppi Fowler have accused the company of shipping returned drugs to its Illinois facility and then reselling the drugs to unsuspecting customers for a second profit.

"Caremark sent those returned drugs from the Florida facility to the Illinois facility in the first instance because Caremark believed it was illegal to re-stock those returned drugs in the state of Florida," the whistleblower lawsuit states. "Indeed, Carlos Gonzales -- a high-ranking member of Caremark's management team at the Illinois facility -- acknowledge[d] that as the basis for such practices."

But the state of Illinois apparently frowns upon selling returned drugs as well. The law there "allows the reselling of returned prescriptions only under very limited circumstances, typically when the drugs have not left the supervision of trained medical staffers," according to the Chicago Tribune.

"Illinois was, like, 'You did what?'" Burns said. "So that's where they're at now."

Risky Business

Caremark has enjoyed kinder treatment in Florida.

There, the attorney general originally declined to join the Fowlers' lawsuit and only changed his mind at the company's own request. Critics quickly raised questions about Caremark's political ties and suggested that the state was less interested in prosecuting the company than it was in derailing the lawsuit. The whistleblowers blocked the attorney general from joining the lawsuit and continue to build their case.