West Marin Pharmacy is facing yet another challenge. Cigna Healthcare, a company that insures as much as 10 percent of the pharmacy’s customer base, stopped covering medication expenses at the pharmacy in May, due to a probation the pharmacy has been on since 2020 after it was found in violation of several safety standards. The decision came at the behest of the insurance company’s pharmacy benefit manager, Express Scripts, and impacts more than 100 customers who patronize the pharmacy, owner Zsuzsanna Biran said.
Though dozens of corporate and a few independent pharmacies line the 101 corridor from Santa Rosa to the Golden Gate Bridge, West Marin Pharmacy is the only one on Marin’s coast. Customers covered by Cigna must now drive over the hill to get their medication paid for by their insurance company.
“If you’re really sick, who wants to drive that windy road?” Ms. Biran said. “Some people don’t even have a car. That is so wrong.”
A spokeswoman for Express Scripts told the Light in an email that the pharmacy’s coverage was terminated after a thorough review by a compliance review committee due to “significant safety standards violations identified by the California State Board of Pharmacy.”
In February, Ms. Biran received a letter from Express Scripts, informing her that Cigna customers would not be covered after May 15, citing a four-year probation the pharmacy is on until May 2024. The probation started in December 2020 and was initially set to last three years, but the board added another year after finding additional violations.
The board’s first investigation of the pharmacy, in 2020, found eight occurrences of malpractice ranging from inadequate safety standards and equipment when compounding drugs to not keeping proper inventory of controlled substances and accepting unused medications from patients without an authorized receptacle.
A subsequent complaint from a customer about inert medication prompted a second investigation in 2021. Though the initial complaint was dismissed, the inspector discovered additional instances of malpractice: CBD products on shelves in the retail area of store, no written notice of consultation for delivery, employees without name badges, an undersized notice to consumers, a log indicating refrigerator temperatures averaging one degree Celsius higher than allowed and a failure to document a review of compounding policies and procedures.
Ms. Biran told the Light that she accepted the disciplinary actions rather than challenging the accusations at the advice of her lawyer. But she said she regrets it now that she is experiencing repercussions.
The decision by the pharmacy benefits manager to cancel coverage threatens the health and safety of her customers, many of whom are elderly and need medication consistently and expeditiously, she said.
“It’s a huge inconvenience for these people,” Ms. Biran said.
Inverness Park resident Christine Cordaro is working with Ms. Biran to raise awareness about the problem. A retired scientist in the biotech industry and a frequent customer at the pharmacy, Ms. Cordaro is encouraging people to contact their elected officials to ask that West Marin Pharmacy be granted an exception from any pharmacy benefit manager removing it from their provider list.
State Senator Mike McGuire said in a statement that he is “working closely with Asm. Connolly and the Attorney General’s office to make sure residents in West Marin can get their prescriptions covered without delay, while keeping in place the necessary guidelines that keep Californians safe. Access to affordable prescriptions is critical for all Californians, especially for seniors and residents of our rural, coastal communities.”
Pharmacy benefit managers such as Express Scripts act as middlemen between pharmaceutical companies, dispensing pharmacies and insurance companies. They establish drug prices, which drugs will be offered on an insurance plan and where patients can get prescriptions filled. They have faced scrutiny for their behind-the-scenes impact on drug access and their preferred providers, which are mostly chain pharmacies.
Thirty-five states have enacted “any willing provider” laws, which protect pharmacies from the withdrawal of a P.B.M. Some laws require pharmacies to meet the standards of their state’s pharmacy board, while others do not. Ms. Cordaro said this type of legislation is essential to empowering local pharmacies like the one in Point Reyes Station.
Though Ms. Cordado is not covered by Express Scripts, she is concerned for her community, and she pointed to the danger of how quickly the issue developed. She said it leaves her insecure about the future of her own coverage.
Karen Kiser, an Inverness resident who takes daily medication, said she specifically chose Cigna last October because the pharmacy was included in its plan. Her coverage was cut three months after she chose her annual Medicare plan.
“The convenience of going to my local pharmacy is gone,” Ms. Kiser said. “They’re the only one in a certain radius of my home. Now I have to drive 50 minutes to find one that is covered.”