Express Scripts agreed to pay a $1.5 million administrative penalty and implement corrective actions following an investigation by the West Virginia Offices of the Insurance Commissioner.
Between May 2024 and August 2025, the state office reviewed the pharmacy benefit manager’s compliance with state law across multiple areas, including reimbursement practices, pharmacy audits, consumer appeals and network adequacy. The review covered Express Scripts’ operations from Jan. 1, 2023, to June 1, 2024.
Investigators cited 28 violations, including failure to reimburse West Virginia pharmacies at the minimum required rates and improper recoupment of funds from pharmacies, according to court documents. The report identified 20,533 impacted claims and 191 instances in which reimbursement for a 30-day supply fell below the state-mandated $35 minimum. The company was also found to have violated review timelines in 100% of consumer appeals reviewed and delayed responses to 50 information requests.
Express Scripts did not admit liability but agreed to reimburse pharmacies with interest and revise internal policies to comply with West Virginia law. The company will submit a corrective action plan and report progress to the state within 90 days.
The settlement follows a broader wave of scrutiny. In February, the Federal Trade Commission reached a deal with Express Scripts over insulin pricing, requiring the PBM to delink rebates from list prices, increase pricing transparency and restructure compensation to pharmacies. That federal case, launched in 2024, remains ongoing for other PBMs.
