CHARLESTON, W.Va. — For several years, independent pharmacies and local chain pharmacies have struggled to stay afloat, and that is no different in 2025.
Last week, it was announced that Fruth, who had been doing business in the Mountain State for over seven decades, would be selling all of its pharmacy licenses to Walgreens.
Owner Lynne Fruth, in a statement, claimed that Pharmacy Benefit Managers, or PBM’s, have been attacking the local pharmacy for years.
“By reimbursing pharmacies less money than a medication costs, PBMs have caused the closure of thousands of pharmacies across America,” Fruth wrote as she announced the decision to sell.
PBMs manage prescription drug benefits for health insurers and employers and essentially manage the drug supply chain. PBMs are often described as a middleman between drug manufacturers, insurance providers and pharmacies.
“They would claim that they try to reduce costs because they’ve got more bodies that they’re taking care of and that they’re able to negotiate better rates, but the fact of the matter is, being the middle men that they are, they are extracting money from the system, which is causing healthcare costs to go up and causing pharmacies to have to dispense medications at a loss on a regular basis,” explained Matt Rafa, president of the West Virginia Pharmacists Association.
“That’s something that is really hard for people to wrap their heads around because you are paying higher co-pays than you’ve ever paid before. I think it’s easy for people to assume that pharmacies are making more money than they have in years past, but the co-pay that they pay plus what the insurance company/pharmacy benefit manager pay us often is still at a loss of what it costs us just to get the medication in stock for you,” he continued.
Rafa said that reimbursement rates are oftentimes not the same across the board. More favorable contracts often go to larger pharmacy chains, while smaller pharmacy chains and independent pharmacies get the short end of the stick.
Rafa says something that adds more insult to injury is PBMs that own large pharmacies, with a perfect example being CVS Caremark, who owns CVS pharmacies.
“Where CVS may report that they are losing money in areas of their business much like many of our independents and small chains in West Virginia, the fact of the matter is, they are filtering a lot of that money up to the PBM, the PBM is making all the money for them, and they’re able to look like they are also struggling in this model,” Rafa said.
According to Rafa, the three biggest PBMs (CVS Caremark, Express Scripts and United Health Care/Optum) account for about 80 percent of all the prescription claims in the United States and they hold all the power.
“With that kind of power, they’re able to give us very unfair contracts that we either have to accept to continue taking care of our patients that we love or we have to refuse them, and our patients have to go elsewhere. Neither one of those is ideal,” Rafa said.
Rafa says the Federal Trade Commission has investigated these types of relationships over the past few years regarding a breach of antitrust laws but not much has come from it.
He believes that things could be changed, but some of those in power don’t want things to change.
“Unfortunately, you’ve got a lot of lobbyists with a lot of money who are really doing everything in their power to try to keep things the way they are because they stand to benefit greatly financially from it, but while they are doing that, they are harming patients and they’re making it harder for pharmacies to survive to take care of those patients,” he said.
Former lawmaker Ken Reed owns multiple independent pharmacies, with one being in Morgan County. He says the local pharmacist typically gets to know a patient better than a large chain ever would, but some things just come down to dollars and cents.
“We’ve been serving these communities for decades. Our pharmacists know everybody, and they all know us,” Reed told MetroNews.
“In the beginning when the PBM began doing this silly stuff, we always thought that the patient would come back because we gave much better service, but in the end, that zero-dollar co-pay overwhelmed the customers because they’re having money issues themselves. Those patients never came back,” he said.
Reed says these pharmacists are often some of the best workers, but they have to do everything they can just to keep the doors open.
“The independents that are left, they are the best of the best. If they’re like me, they have already implemented draconian measures to stay open,” Reed said.
Pharmacy deserts
As Fruth is prepared to close its pharmacies this week and many independent pharmacies have also shut down, professionals worry about “pharmacy deserts,” where rural customers will be left without local care.
Rafa says Fruth’s closures will create even more deserts in a state that already has plenty that need addressed.
“When we start seeing closures like the unfortunate closures of the 15 Fruth stores, that leaves holes of care in those areas,” Rafa said. “Especially when they are in rural locations, they may be the only pharmacy in town, or they may be the only health establishment in that small community. The patients in that community rely greatly on that pharmacist and the staff to take care of their needs.”
To prevent pharmacy deserts, Rafa believes residents should be able to get the same prescription at their local pharmacy for the same price as larger pharmacies. He says with how PBMs are dictating the landscape, the local pharmacy is under attack.
“We’re definitely in dire times where a lot of our pharmacies are doing everything they possibly can to keep their doors open because they know how important the care that they offer to their patients is in those communities,” said Rafa.