West Virginia
Contractor for W. Va. public employees system pays itself way more for some drugs than necessary – Ohio Capital Journal
Express Scripts, the company that handles drug transactions for West Virginia public employees has — in some cases — paid itself more than 100 times as much for the most expensive class of drugs than it could have paid if it had gotten them elsewhere, according to pricing data obtained by the Ohio Capital Journal.
Express Scripts — which is the subject of an antitrust suit in Ohio — did not dispute the data, but a spokesperson said that the company uses its heft as a pharmacy middleman to save customers money. And both Express Scripts and the West Virginia Public Employees Insurance Agency said that one can’t just look at reimbursements for select drugs and draw conclusions about the plans’ overall performance.
Neither responded to some specific questions about Express Scripts’ practices.
In a rapidly consolidating marketplace where just a few players control an ever-wider swath of transactions, Express Scripts is not alone in awarding its own pharmacies huge markups. Similar instances have been found in other insurance systems in other states.
Paying itself and its competitors
The West Virginia Public Employees Insurance Agency, or PEIA, uses St. Louis-based Express Scripts as its pharmacy benefit manager. In that capacity, Express Scripts agrees to cover medications in exchange for discounts from drugmakers. It reconciles claims at the pharmacy counter. It bills the state.
And crucially, it determines how much to reimburse pharmacies that fill prescriptions for the agency.
When it comes to “specialty” drugs — think medicines for diseases such as cancer that can cost thousands of dollars a month — Express Scripts requires PEIA members to get their medicines from its own mail-order pharmacy, Accredo, or from a network of 20 specially qualified pharmacies.
Those pharmacies are located only in patches of West Virginia. There are six in Huntington, two in Morgantown, one in Gallipolis, Ohio, but none in Charleston, the capital city where many state employees and retirees live, according to a list provided by the West Virginia Department of Administration. The others are scattered in small communities across the state.
So it’s unclear how many PEIA members have much of a choice about using a pharmacy other than Accredo when they or their family members are unlucky enough to need a specialty drug.
But it is clear that for at least 23 specialty drugs, Express Scripts has at times paid wildly more to its own mail-order pharmacy than it would have if it used prices listed on publicly available databases.
Fruth Pharmacy owns 17 stores in West Virginia, six in Ohio and one in Kentucky. Late last year, President Lynne Fruth received Accredo pricing information obtained through the PEIA patient portal that contained some eye-popping numbers.
For example, at least sometimes Express Scripts’ Accredo charged West Virginia taxpayers $4,300 for a month’s supply of the prostate cancer drug abiraterone. That’s 110 times as much as the $39 you would pay if you were charged the price on a database kept by the federal government — National Average Drug Acquisition Cost, or NADAC, — plus a $10 dispensing fee.
In the case of the brain cancer drug Temozolomide, the Express Scripts-owned pharmacy charged $12,000 a month more than a Kentucky Medicaid patient would have to pay, according to the Fruth analysis, done by Andy Becker, Fruth’s vice president for pharmacy.
Express Scripts was paying its mail order pharmacy $13,118 a month in taxpayer money for the drug on that day. But a maximum-allowable cost list published by the Kentucky Department of Medicaid priced the drug at $900, according to Becker’s analysis.
In all, it listed 23 drugs for which public pricing was available. Of those, Express Scripts/Accredo upcharges ranged from $109 a month to $12,000. Markups on 17 of the drugs exceeded $2,000 a month.
Who benefits?
The Capital Journal shared the analysis with Express Scripts and West Virginia state officials.
While the size of the markups might appear to be startling, Express Scripts spokeswoman Justine Sessions said they only represent a small selection of the prescriptions her company handles for PEIA.
“Choosing isolated examples of individual medications among the thousands covered by PEIA’s plan does not provide meaningful insights about the overall medication cost, affordability and safety that we help ensure for them and their members,” Sessions said in an email.
In an interview, Fruth said that she didn’t believe Accredo was taking losses on other drugs that came anywhere near matching the markups it was getting on those in Becker’s analysis.
“If it’s OK for you to pay $11,000 for a $900 drug, show me somewhere that you’re dispensing an $11,000 drug and paying only $900 for it,” she said. “I’m absolutely certain that you can’t show me that.”
Analyses show that having only a few drugs responsible for large profits is not unusual.
The drug-pricing analysis firm 3 Axis Advisors in 2020 examined Florida Medicaid data and found that for generic medications, just 1.3% of the drugs dispensed accounted for nearly half (48.3%) of the markups over the prices listed on the NADAC database. In other words, huge markups on a tiny slice of drugs accounted for a huge portion of the profit being taken out of the program.
Also, the Wall Street Journal in September analyzed the cancer drug imatinib and determined that CVS Caremark and Express Scripts — the two largest pharmacy benefit managers — were paying well over 100 times as much for the medication than was Mark Cuban’s Cost Plus Drug Company, which charges a straight 15% markup plus $10 in shipping and dispensing fees. The big PBMs were in many instances paying those high prices to their own mail-order pharmacies, according to the analysis.
In the case of the West Virginia Public Employees Insurance Agency, it’s unclear what portion of expensive specialty drugs are being filled by Express Scripts’ Accredo pharmacy, and what portion is being filled by the members of the 20-store specialty network.
When asked for a specific breakdown, Express Scripts’ Sessions didn’t provide one, saying instead, “The large majority of specialty pharmacy claims are dispensed by network pharmacies other than Accredo.”
Becker of Fruth Pharmacy said his company and others are reluctant to join the network. They suspect that while Express Scripts is reimbursing its own mail-order pharmacy lavishly, it reimburses competitors at rates that don’t meet their costs.
“They’re not going to pay you $1,000 for a $50 drug,” Becker said. “They’re going to pay you $20 for a $50 drug.”
Express Scripts spokeswoman Sessions was asked whether Express Scripts reimbursed its own mail-order pharmacy the same amount for the same drug on the same day as it does and those in its specialty network.
“We offer in-network pharmacies competitive reimbursement rates,” she said.
Congressional concern, investigations and a lawsuit
Sessions said her company’s contract with the tax-funded West Virginia Insurance Agency guarantees savings.
“We ensure that customers receive the best discount on each fill — regardless of where they choose to access their prescriptions,” she said. “Because we offer pricing guarantees that help to control drug spend across drug categories over an annualized period of time, our clients often pay less for drugs overall. Should we fail to meet the pricing guarantees, we make up the financial difference for our clients, which can translate into savings for members.”
But members of the U.S. Senate and other public officials have been questioning such statements.
In the wake of the Wall Street Journal’s reporting last year, U.S. Sens. Elizabeth Warren, D-Mass., and Mike Braun, R-Ind., wrote Cristi Grimm, Inspector General of the Department of Health and Human Services.
They noted that each of the nation’s big-three pharmacy benefit managers is part of a “vertically integrated” health giant that also combines a major insurer and pharmacy — at least of the mail-order variety. They are: Cigna/Express Scripts, CVS/Aetna and UnitedHealth/OptumRx.
The latter two companies have been also buying up doctors’ offices and if Cigna/Express Scripts is successful in buying Humana, it will be getting into that business as well.
When Braun and Warren say the businesses are vertically integrated, they mean they’re major players in multiple sectors that do business with each other, raising concerns about self dealing. For example, an in-network CVS/Aetna doctor could write a prescription that would be filled at an in-network CVS pharmacy, which would be reimbursed by CVS Caremark, which controls pharmacy networks. Since CVS would be paying itself at each step, it would remove the incentive to keep costs down.
Referring to the high prices for specialty drugs that the Wall Street Journal found the companies paid themselves, Braun and Warren wrote, “One key factor driving these high prices appears to be the fact that insurers own other key links in the drug supply chain: pharmacy benefit managers (PBMs) and pharmacies.”
They continued,”Cigna/(Express Scripts), UnitedHealth/(OptumRx), and CVS/Aetna each own or are affiliated with the country’s three largest PBMs, which in theory negotiate drug prices with pharmaceutical manufacturers on behalf of insurers and set prices at the pharmacy. However, when those same insurers and their vertically integrated PBMs also own their own specialty pharmacies, they can profit handsomely. That’s because insurers are not just the payers at the end of the transaction; instead, through their PBMs and pharmacies, they are also the recipients of those funds.”
Regulators and law enforcement are taking note.
In 2022, the Federal Trade Commission announced a major investigation into the practices of the big pharmacy benefit managers.
Then last May, Ohio Attorney General Dave Yost sued Express Scripts, Humana and others under state antitrust law, essentially accusing them of colluding behind a veil of secrecy to fix prices and punish companies that go against them. In the suit, Yost also goes after Ascent, a Switzerland-based “group purchasing organization” formed by Express Scripts’ parent company in 2019. Critics say the purpose of its formation is to avoid scrutiny of its drug-pricing practices.
CVS and UnitedHealth have formed similar companies in recent years. The FTC last year added those companies to its antitrust probe.
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CHARLESTON, W.Va. (WSAZ) – West Virginia Virtual Academy celebrated its second graduating class Tuesday at the Clay Center.
The ceremony featured a keynote speech and performance from West Virginia native and season six winner of America’s Got Talent’ Landau Eugene Murphy Jr., where he set out to inspire the class.
The class graduated 140 students, with eight earning a Promise Scholarship and 26 intending to attend college in the fall.
The academy’s director Doug Cipoletti said the virtual learning is about more than sitting behind a screen.
“Then we provide this [ceremony] where kids can actually come together and meet one another and build those relationships,” Cipoletti said. “So yes, we’re a virtual school, but there’s a lot more to it than just being behind a computer and I think that really shows today.”
West Virginia Virtual Academy is a K-12 school.
Copyright 2026 WSAZ. All rights reserved.
West Virginia
West Virginia Democrats have an open competition at the top of the state party – WV MetroNews
West Virginia Democrats have a competition for leader of the state party.
Teresa Toriseva, who currently serves as first vice chair of the West Virginia Democratic Party, says she is running for the top spot currently held by Mike Pushkin, who also serves as a state delegate from Charleston.
“This is not a civil war within the Democratic Party. On the contrary, the party is quite unified in message and in mission. And that’s what I found as I’ve been campaigning to run for chair, and I’ve never believed it to be more true,” Toriseva said on MetroNews Midday. “It’s an exciting time for what is a growing, robust opposition party.”
But, “There has been a call for us to prepare for the future better and differently than the past and one of those things that I’m going to be focusing on is building relationships with coalition members from groups that think like us, groups that want to work together with us, from labor to women’s groups to organizing groups that are on the ground doing the work, bringing messages to voters.”
Toriseva is a Wheeling attorney who ran in 2024 for state attorney general, losing in the general election.
Democrats, which used to be the dominant political party in West Virginia, now have almost 327,000 registered voters in the state, about 27% of the overall number of registered voters.
The Republican Party has more than 521,000 registered voters, about 43% of the total number.
Toriseva says Democrats have had a successful period of candidate recruitment that can serve as a base for revitalization.
“Democrats are back, and does that mean we’re going to look like we did a decade ago? No, it’s a new party, and we’re moving forward in a new way, but the future is going to look very different than the past,” she said.
Democrats, under the direction of their own bylaws and state code, are having an organizational meeting at 3 p.m. Saturday in Charleston. The meeting’s focus will be on the election of officers. The meeting will be broadcast to the public via wvdemocrats.com/live
Toriseva has worked alongside Pushkin as one of the top officers of the party for the past several years.
“It’s either have an election now or anoint the incumbent for four more years, and so I do think that elections are healthy, that competitive elections are a sign of a growing and robust party and I don’t think that it’s any indication of a civil war,” Toriseva said.
Pushkin, in response, agreed that anyone is entitled to run for chair and make their case to the members of the executive committee.
And he said the resurgence of the West Virginia Democratic Party has been the result of the hard work of county committees, labor organizations, women’s clubs, Young Democrats, grassroots activists, candidates and countless volunteers across the state.
“What leadership does deserve credit for is creating a plan, bringing people together around that plan, and providing the tools and support necessary to execute it. Our record-breaking candidate recruitment effort did not happen by accident,” Pushkin said.
He said party leaders developed an organizing strategy, held weekly recruitment calls, engaged county leaders and allied organizations, launched the first large-scale candidate recruitment texting program in party history and raised funds to cover filing fees for candidates willing to step forward and put their names on the ballot.
“The question before us now is not who gets credit. The question is whether we continue building on that momentum or allow ourselves to become distracted by internal disagreements while Republicans remain deeply divided,” Pushkin said.
“My focus remains exactly where it has always been: bringing Democrats together, supporting our candidates and taking the fight to Republicans every single day.”
West Virginia
More Mountaineer magic: Guzman’s walk-off single in 10th sends West Virginia to 6-5 win over Kentucky in regional championship – WV MetroNews
GRANVILLE, W.Va. — It was never going to be easy.
Not with the recent history in the Kentucky-West Virginia series, which consisted of four postseason contests decided by one or two runs across the last two years ahead of Monday’s meeting in the Morgantown Regional Championship at Kendrick Family Ballpark.
Sure enough, Kentucky strung together five straight hits with two outs in the eighth, including a three-run home run from Hudson Brown and a solo shot from Ethan Hindle to tie the winner-take-all affair at 5.
But West Virginia has consistently shown the ability to not waver, including one night earlier when it rallied with five runs in the ninth inning to knock off the Wildcats, 11-9.
This time around, the Mountaineers relied on pitcher Dawson Montesa in relief one day after a 122-pitch outing against Wake Forest. Montesa recorded a pair of pivotal outs in the top of the 10th inning, setting the stage for Armani Guzman’s walk-off single to center in the bottom of the 10th that gave WVU a 6-5 victory.
“That was fun. I couldn’t draw it up any better,” second-year WVU head coach Steve Sabins said. “Everything that you love about coaching and everything you love about players was on full display this weekend. It was cinema and had literally everything you can imagine. If you keep going and stick through adversity, then you can do incredible things.”
With the win, West Virginia (43-15) will play host to Cal Poly (39-22) in a best-of-three Super Regional series with the winner advancing to the College World Series. The Mountaineers and North Carolina are the only teams to qualify for a Super Regional each of the last three years.
Guzman’s single came off of Jack Bennett, who began his outing with 14 consecutive strikes and retired six straight Mountaineers over the eighth and ninth innings collectively.
“That was my third at bat against him,” Guzman said. “He got me to pop out on change-ups twice. That at bat, I wanted to see him deeper. I wanted to hit the ball as hard as I could and stay composed.”
The bottom of the 10th began with Brodie Kresser’s leadoff single against Bennett, who then missed with a full count offering to Ben Lumsden that put two on to start the inning.
Tyrus Hall then got ahead 2-0, but popped up a sacrifice bunt attempt for the first out.
Disappointment didn’t last long as Guzman got ahead 2-0 and hit a solid single that allowed Kresser to score the winning run.
It was another memorable postseason moment from Guzman, who a year ago was named MVP of the Clemson Regional.
“He likes the moment. He loves to win,” Sabins said of Guzman. “He’s probably the best athlete in the country. That doesn’t hurt him either. I love his makeup and mentality.”
Game 7 of the Morgantown Regional had a little bit of everything, including a bounce-back effort from Maxx Yehl.
The Big 12 Pitcher of the Year was knocked around and didn’t make it out the first inning Friday in what amounted to an 11-9 loss to UK.
This time around, he worked five effective innings and allowed one run on three hits. The southpaw struck out six without issuing a walk and was efficient, throwing 42 of 67 pitches for strikes.
“Grateful the coaches believed in me to give me the ball,” Yehl said, “and I was excited to get back out there and help the team win.”
After keeping UK (33-23) off the scoreboard in the top of the first, Yehl returned to the mound in the second the beneficiary of a 1-0 lead after a dropped third strike allowed Sean Smith to reach and Gavin Kelly to score from third. Kelly had doubled with one out off Wildcats’ starting pitcher Jackson Soucie.
Guzman’s speed was the biggest factor in WVU doubling its lead in the third.
He reached on a bunt single, stole second on a failed pickoff attempt, moved to third on Kelly’s groundout and crossed the plate on a Paul Schoenfeld groundout.
Brown’s solo home run off Yehl in the fourth allowed the Wildcats to get back to within one run.
Yehl induced an inning-ending double play off the bat of Owen Jenkins to end the top of the fifth and the Mountaineers put together their best offensive inning in the bottom of that frame.
It began with Guzman’s double to left, which was followed by Kelly’s base-on-balls and a run-scoring single from Schoenfeld.
Matthew Graveline made it a three-run margin later that inning when he doubled to plate Kelly.
Kelly’s solo home run in the sixth — his third of the regional and 16th this season — left WVU with a 5-1 advantage. He was named Most Valuable Player of the Morgantown Regional.
“It’s a team MVP. It’s unreal the stuff that everybody on this team did,” Kelly said. “Everyone on the team deserves that. We have a team full of MVPs. It’s hard to kill when you have that.”
Ian Korn made that lead hold up until the eighth despite retiring the first two batters of that inning. Tyler Bell prolonged it with a single, Luke Lawrence followed with another and Brown belted his second long ball of the night to bring UK to within one run.
“We weren’t trained at any point throughout the year to ever think we’re out of a game,” Brown said. “Coach always tells us to keep fighting.”
Hindle made it back-to-back home runs, at which point Korn was lifted for Chansen Cole.
Cole allowed a single to Braxton Van Cleave, but struck out Tyler Cerny to end the inning.
In the ninth, Cole issued a leadoff walk to Carson Hansen, but he was stranded at second.
Kentucky then made consistent hard contact against Cole in the 10th, including several foul balls by mere inches that otherwise likely would’ve gone as extra-base hits.
With Cole and Hindle involved in a lengthy battle, Sabins elected to pull Cole mid at-bat in favor of Montesa, who entered with the count 1-2.
Montesa ultimately walked Hindle, which left Kentucky with runners at first and second and one out. But the right-hander, whose velocity was in the high 90s, followed it up by striking out Van Cleave and got Cerny to fly out to left for what wound up Kentucky’s final at bat of the season.
“I was like I don’t know if we have something left in the tank to get this dude out,” Sabins said. “We might be standing here watching the next pitch as a Wildcat crosses home plate. We rushed Montesa. It wasn’t exactly a genius move, but it ended up playing out well.”
Montesa recorded his second win in as many days by recording the last two outs of the 10th.
Guzman led WVU and all players with three hits.
Brown drove in four of his team’s five runs.
“I would think anybody that watched our team play would have to respect what we’ve been able to do,” UK coach Nick Mingione said. “Not an easy place to play like anywhere on the road in our league, but anybody that follows baseball, I really believe they would say we have gained a lot of respect.”
The third largest crowd in Kendrick Family Ballpark history of 4,607 took in the instant classic.
“It’s been cemented that this is the best college baseball atmosphere in the country,” Sabins said. “Nowhere can provide the energy that just happened in Morgantown. The place was absolutely electric.”
All-Morgantown Regional Team
C: Matt Conte, Wake Forest
1B: Armani Guzman, West Virginia
2B: Gavin Kelly, West Virginia
SS: Tyler Bell, Kentucky
3B: Tyrus Hall, West Virginia
LF: Ben Lumsden, West Virginia
CF: Javar Williams, Wake Forest
RF: Braxton Van Cleave, Kentucky
DH: Luke Lawrence, Kentucky
P: Chansen Cole, WVU
P: Dawson Montesa, WVU
Regional MVP: Gavin Kelly, WVU
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