A.G. Schneiderman Announces Settlement With Walgreens For Sticking NYS Empire Plan Members With Flu Shot Bills

NEW YORK - Attorney General Eric T. Schneiderman today announced a settlement with the Walgreen Company following an investigation that determined that over 3,000 individuals insured by the NYS Empire Plan were misled by Walgreens into thinking they were covered for flu shots administered at the pharmacy, when they were not. Today's settlement requires Walgreens to cease advertising free flu shots for Empire Plan members and to refund payments to consumers who were forced to pay for flu shots out of their own pocket. The Attorney General also provided tips to protect health care consumers from having to pay unnecessary costs this flu season.

"Vaccinations are a key public health strategy in preventing the spread of the flu in New York State and nationally," said Attorney General Schneiderman. "By refunding customers, this settlement will ensure that Walgreens will not contribute to any consumer confusion that could negatively impact public vaccination efforts. While our office supports the increased availability of vaccinations through retail pharmacies, stores like Walgreens must be prepared to let consumers know whether their flu shots are covered by an insurance plan when administered at their stores."

According to the Centers for Disease Control and Prevention, thousands of U.S. citizens die each year from the flu and its complications, and hundreds of thousands are hospitalized. For that reason, complaints from the public alleging coverage or reimbursement problems associated with the flu vaccine are treated by the Office of Attorney General as both a public health and a consumer issue.

Attorney General Schneiderman's office commenced an investigation into Walgreens' flu vaccination and billing practices after receiving complaints through its Health Care Bureau Helpline that the pharmacy incorrectly advertised and informed Empire Plan members that it participated with their health plan and could provide flu shots to them at no out-of-pocket cost. However, flu shots for Empire Plan members are only covered when administered in a physician's office. The investigation uncovered that 3,000 Empire Plan members were vaccinated at various Walgreens retail pharmacies during the 2010 and 2011 flu seasons. After the Empire Plan insurance claims were denied as a non-covered service, Walgreens billed the members for the $30 cost of the vaccine. Of the 3,000 billed, 1,647 consumers paid the full amount out of their pockets, and will be reimbursed as a result of the settlement.

As a result of the Attorney General's investigation, Walgreens will cease advertising and representing that flu vaccines administered by Walgreens are covered under the Empire Plan, which insures more than 2.5 million New York State employees, retirees and their dependents. It will review all insurance claims submitted for Empire Plan members for the period of August 15, 2010 through the present, and identify and reimburse those Empire Plan members who paid for flu shots during that time. Walgreens also agreed to:

Cease billing Empire Plan members for flu vaccinations administered between August 15, 2010 and the present;
Ensure that its retail pharmacy staff accurately communicate flu vaccination coverage information to Empire Plan members;
Submit a report to the Attorney General documenting the Empire Plan members to whom refunds were paid; and
Pay costs to the State in the amount of $15,000.

The Attorney General provided tips for New Yorkers during this flu season:

Beware of retail pharmacy advertising that implies "free" flu shots or that flu shots are covered by "most plans."
Before you get a flu shot in a retail pharmacy, make sure that you know whether your insurance plan covers the cost of flu shots administered in a retail pharmacy. Some plans do not.
Ask your pharmacist if he/she can confirm that your shot is covered. If he/she cannot confirm, you may end up being responsible for the bill after the fact.
If the pharmacy or store cannot confirm whether your shot is covered, let the store central headquarters know that you want the pharmacy to be able to tell you about whether the shot is covered under your plan before getting the shot.

Consumers with questions or concerns about this or other health care matters may call the Attorney General’s Health Care Bureau Helpline at 1-800-428-9071.