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Amid controversy over the use of patient coupons, Pfizer has agreed to refund $290,000 to settle charges of misleading roughly 5,000 people in Colorado, Kansas, Vermont, and Arizona who spent much more than expected when they used coupons supplied by the drug maker. The company will also pay a total of $120,000 to the states to cover legal costs, among other things.

This is only the latest instance in which Pfizer has been cited over such allegations. Three years ago, the company paid $975,000 to settle charges of misleading consumers in Oregon and, in 2018, it reached a $700,000 settlement with New York State. In each episode, consumers were told they would “pay no more than” a small amount of money — typically, from $15 to $25 — for certain drugs, but were actually required to pay more due to limits on total savings that were not prominently disclosed.

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