West Virginia Pharmacies and Patients Still Under Attack by Pharmacy Benefits Managers

The West Virginia Independent Pharmacy Association (WVIPA) is sounding the alarm about predatory practices of Pharmacy Benefit Managers (PBM) in West Virginia. PBM practices are driving independent community pharmacies out of business. This hurts patients and drives up health care costs across West Virginia.

“The WVIPA started in 2017, with a small, brave group of independent community pharmacy owners, seeking to protect pharmacies and patients from PBMs that were harming their businesses and making prescription drug decisions with no regard for patient access or quality of care – only profit.  Since, the WVIPA has lost over half of its initial board membership to closures and acquisitions.  Dozens of locally owned and operated pharmacies are gone - community leaders like Loop Pharmacy, Drug Emporium, Bypass Pharmacy, Fritz’s Pharmacy, Family Discount Pharmacy, Oceana Pharmacy, Chapmanville Pharmacy, and now, Fruth Pharmacy,” said Matt Walker, WVIPA Executive Director.

Pharmacy benefits are largely controlled by three large PBMs – Express Scripts (owned by Cigna), CVS Caremark (owned by CVS Health), and Optum Rx (owned by UnitedHealth Group).  These three PBMs control more than 80% of prescriptions in the United States, and often reimburse pharmacies less than the cost of acquiring medications.  PBMs also affiliate with and own competing pharmacies, which creates unfair competitive advantages.

The West Virginia Public Employees Insurance Agency (PEIA) currently uses Express Scripts as its PBM.  Express Scripts and other PBMs have been fined millions of dollars, and have been ordered to pay pharmacies $15million+ in restitution by the West Virginia Offices of the Insurance Commissioner (WVOIC) for violations of West Virginia law.

This week, Lynne Fruth, President and CEO of Fruth Pharmacy, released the following statement:

“Fruth was critical in providing testing and vaccinations during the pandemic and fighting for legislation to ensure that pharmacies could survive in rural areas.
Fruth pharmacists have provided excellent care in their communities by putting patients first. Pharmacies have been under attack by greedy PBMs (Pharmacy Benefit Managers) for many years. By reimbursing pharmacies less money than a medication costs, PBMs have caused the closure of thousands of pharmacies across America. The continued closings of pharmacies must be a wake up call for lawmakers to hold PBMs accountable before all pharmacies disappear.”

According to Mike Rudge, WVIPA Board President, “West Virginia has some of the strongest pharmacy laws in the country, but pharmacies are still closing.  We often hear about policy changes and how those might result in reduced access to health care and closures in certain areas – West Virginia’s independent pharmacies are being attacked by large PBMs, and they are closing rapidly.  This is not hyperbole – these are real pharmacy closures.”

In many rural West Virginia counties, Medicare pharmacy reimbursement has been slashed so low by PBMs, pharmacies are being forced to either opt out of participation, which limits patient access, or lose money on most prescriptions dispensed.  More than a quarter of West Virginia’s population is enrolled in Medicare.

Put simply:  West Virginia’s pharmacies cannot survive under the current PBM model.  If current trends continue, there will be no independent pharmacies left, a tremendous loss to West Virginia communities.