CVS Caremark and CareFirst class action overview:
- Who: Plaintiff Martin Hamburger filed a class action lawsuit against CVS Caremark and Group Hospitalization and Medical Services Inc., doing business as CareFirst BlueCross BlueShield.
- Why: Hamburger claims the defendants wrongfully denied coverage for Zepbound, a drug to treat obstructive sleep apnea.
- Where: The CVS Caremark and CareFirst class action lawsuit was filed in District of Columbia federal court.
A new class action lawsuit alleges CVS Caremark and CareFirst BlueCross BlueShield wrongfully denied coverage for Zepbound, a drug to treat obstructive sleep apnea, in violation of the Employee Retirement Income Security Act of 1974 (ERISA).
Plaintiff Martin Hamburger filed the class action complaint against CVS Caremark and CareFirst on Sept. 4 in District of Columbia federal court.
Hamburger alleges the defendants’ standard practice of categorically excluding coverage for Zepbound violates ERISA and the terms of the health benefit plans they administer.
According to the lawsuit, Zepbound is the only prescription medication approved by the U.S. Food and Drug Administration for obstructive sleep apnea. Despite this, Hamburger claims CVS Caremark and CareFirst have denied coverage for the drug, even though their health plans promise to cover prescription medications for conditions like sleep apnea.
CVS Caremark, CareFirst misled patients about Zepbound coverage, lawsuit claims
Hamburger says he has been diagnosed with moderate obstructive sleep apnea since 2015 and requires Zepbound for treatment. However, he claims the defendants have wrongfully denied coverage for this medically necessary drug.
The lawsuit argues that the sole basis for the denial is the CareFirst Plan’s exclusion of Zepbound, which Hamburger claims contradicts the plan’s terms and ERISA requirements.
The lawsuit further alleges that the defendants’ denial of Zepbound coverage reveals a claims procedure that operates outside of established ERISA requirements.
Hamburger claims the defendants failed to ensure that decisions were made in accordance with governing plan documents and did not consider all information submitted with claims or appeals.
As a result, Hamburger is seeking an injunctive order requiring the defendants to review claims for Zepbound coverage in compliance with ERISA.
He wants to represent anyone who has been, are or will be participants or beneficiaries covered under ERISA welfare benefit plans administered by CareFirst BlueCross BlueShield with pharmacy benefit management programs administered by CVS Caremark and required or will require Zepbound for the purpose of treating obstructive sleep apnea from Dec. 20, 2024, to the present.
Meanwhile, CVS Health Corp. recently faced a class action lawsuit alleging it violated the Telephone Consumer Protection Act by sending telemarketing texts to individuals on the National Do Not Call Registry.
What do you think of the claims made in this CVS Caremark and CareFirst class action lawsuit? Let us know in the comments.
The plaintiff is represented by Robert Baldwin III of Virtue Law Group and Paul J. Lukas, Brock J. Specht, Patricia C. Dana and Cole A. Birkeland of Nichols Kaster PLLP.
The CVS Caremark and CareFirst class action lawsuit is Hamburger v. CVS Caremark, et al., Case No. 1:25-cv-03000, in the U.S. District Court for the District of Columbia.
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