Why It Matters
Helena Buonanno Foulkes’ leadership of CVS Pharmacy during a period when the chain allegedly filled prescriptions from illegal pill mills has become a central issue in her bid to return to Rhode Island politics. Her record at the company—and the state’s role in regulating the opioid crisis—sits at the center of a 2024 gubernatorial campaign dispute.
What Happened
Foulkes served as president of CVS Pharmacy from January 2014 through February 2018. During that tenure, the federal government alleges the chain knowingly filled illegitimate opioid prescriptions from doctors operating as pill mills. The U.S. Department of Justice filed suit in U.S. District Court in Providence, claiming CVS failed to act as a gatekeeper against dangerous prescription distribution.
The complaint names seven doctors whose conduct allegedly involved CVS misconduct. For six of those doctors, the bulk of the misconduct occurred while Foulkes led the pharmacy division. In one case, CVS continued filling prescriptions for a doctor despite repeated escalations before stopping only weeks after a federal grand jury indictment. In another, CVS filled prescriptions from a doctor from at least 2014 until blocking that prescriber in 2017—a year after the DEA raided the doctor’s office in March 2016.
In 2022, CVS agreed to pay $5 billion to settle lawsuits from thousands of cities, counties, states, and tribal governments. The company also paid more than $70 million in fines following DOJ investigations into opioid-related conduct across 11 states.
Governor Dan McKee, who defeated Foulkes in the 2022 Democratic primary by three percentage points, has renewed campaign attacks on her record. McKee launched a website and attack advertisements linking Foulkes to the opioid crisis after she announced her 2024 gubernatorial run.
Foulkes’ Defense
Foulkes claims that CVS cut off “over 600 pill mill docs” during her tenure as pharmacy president. Her campaign confirmed that “roughly 600” cutoffs occurred during those years. CVS stated in a 2024 response that it has blocked more than 1,250 practitioners total across its history, including nearly 600 prescribers.
Her campaign also cited testimony from a 2021 Ohio civil trial in which a CVS vice president testified that the company offered the DEA a list of suspended doctors, which the agency “refused to take.” The DEA declined to comment on Foulkes’ claim regarding agency inaction.
Then-U.S. Attorney for the District of Rhode Island Zachary Cunha stated in federal filings that “CVS failed to exercise its critical role as gatekeeper of dangerous prescription opioids and, instead, facilitated the illegal distribution of these highly addictive drugs, including by pill mill prescribers.”
By the Numbers
$5 billion — CVS settlement payment in 2022 to resolve opioid-related lawsuits from multiple jurisdictions
$70 million — CVS fines following DOJ investigations into opioid conduct
11 states — number of states involved in DOJ investigations of CVS opioid practices
Over 600 — pill mill doctors Foulkes claims CVS discontinued during her tenure
Roughly 600 — pill mill cutoffs confirmed by Foulkes’ campaign during her 2014-2018 leadership
More than 1,250 — total practitioners CVS has blocked since the company began such enforcement
Nearly 600 — prescribers among the total blocked who government agencies continue to license
Zoom Out
The opioid crisis has become a defining policy issue across U.S. gubernatorial races. Multiple states have pursued major settlements against pharmaceutical manufacturers and retailers over their role in fueling addiction epidemics. CVS’s $5 billion settlement ranks among the largest corporate payouts for opioid-related claims nationally.
Foulkes’ case illustrates how corporate opioid decisions made during the height of the crisis continue to haunt executives who now seek public office. Similar disputes over pharmaceutical industry accountability have surfaced in other state elections and remain a focal point for voters concerned with addiction policy.
What’s Next
The 2024 Rhode Island gubernatorial campaign will likely continue to center on competing interpretations of CVS’s opioid record and Foulkes’ role in company decisions. Voters will ultimately weigh her record on pharmaceutical accountability against her broader policy platform as the primary unfolds.