Express Scripts Faces Lawsuit Over Arkansas Pharmacy Reimbursement Rates
Key Takeaways
- Twelve independent Arkansas pharmacies allege Express Scripts repeatedly reimbursed prescription claims below the state-mandated minimum based on National Average Drug Acquisition Cost (NADAC).
- The lawsuit cites Arkansas Act 990, which allows pharmacies to pursue certain reimbursement violations and potentially recover statutory damages.
- The case highlights financial and administrative concerns surrounding pharmacy benefit manager (PBM) reimbursement practices, particularly for independent and rural pharmacies.
Twelve independent Arkansas pharmacies have filed a lawsuit against Express Scripts, alleging the PBM repeatedly reimbursed them below the minimum amount required under Arkansas law for prescription drugs. The complaint alleges tens of thousands of underpayments across hundreds of medications and seeks statutory damages of up to $10 000 for each violation, along with compensatory damages and injunctive relief.1,2
The lawsuit, filed September 15, 2026, in the Circuit Court of St. Louis County, Missouri, names Achor Family Pharmacy and 11 other independent Arkansas pharmacies as plaintiffs. The case was filed in Missouri because Express Scripts maintains its principal place of business in St. Louis County and, according to the complaint, its provider manual designates the county as a forum for disputes.1,2
Pharmacies Allege Reimbursements Fell Below NADAC
At the center of the dispute is the NADAC, a drug-specific benchmark used to estimate what pharmacies pay to acquire medications. Under Arkansas law, the complaint states, PBMs may not reimburse Arkansas pharmacies below NADAC for the ingredient cost of a prescription.1
The pharmacies allege Express Scripts repeatedly violated this reimbursement floor. According to the complaint, the PBM reimbursed the plaintiffs below the statutory minimum tens of thousands of times across hundreds of drugs.1
The plaintiffs contend Express Scripts possessed the information necessary to comply with the requirement at the time each claim was processed, including the drug's National Drug Code, quantity, fill date, and applicable NADAC information.1
Arkansas Law Allows Pharmacies to Pursue PBM Claims
The pharmacies are bringing their claims under Arkansas Act 990, which took effect August 5, 2025. The law authorizes pharmacies, pharmacists, and businesses providing pharmacy services to bring private actions for certain violations of the state's pharmacy reimbursement requirements.1
Under the law, a prevailing plaintiff may recover attorneys’ fees and costs, while violations pursued under the Arkansas Trade Practices Act may result in statutory damages of up to $10 000 per violation.1
The plaintiffs argue that every prescription claim reimbursed below the statutory floor on or after the effective date of Act 990 constitutes a separate violation. Their claims for statutory damages under the law are limited to reimbursements occurring on or after August 5, 2025.1
The complaint also points to earlier regulatory scrutiny of below-NADAC reimbursements. According to the filing, by April 2024, the Arkansas Insurance Department was processing approximately 1000 to 1500 below-NADAC claims per month across multiple PBMs.1
Pharmacies Cite Financial and Operational Burdens
The plaintiffs argue that below-cost reimbursement can place financial pressure on independent pharmacies because pharmacies generally purchase medications before dispensing them and must rely on PBMs for reimbursement after claims are submitted.1,2
They also contend that the appeals process can create additional administrative costs. A pharmacy challenging an alleged underpayment may need to identify the claim, collect invoices, submit an appeal, monitor the dispute, and reconcile any subsequent correction. According to the complaint, the labor associated with challenging smaller underpayments may exceed the amount in dispute.1
Several plaintiffs operate in rural communities where independent pharmacies may serve as a principal or, in some cases, the only local source of prescription medications and pharmacist services.1,2
Legal Claims and Relief Sought
The lawsuit alleges violations of Arkansas pharmacy reimbursement requirements and seeks both monetary and prospective relief. The pharmacies are requesting compensatory damages and actual financial losses; statutory damages of up to $10 000 per violation; payment or reprocessing of allegedly underpaid claims where authorized; interest; attorneys’ fees and costs; and declaratory and injunctive relief.1
The plaintiffs are also asking the court to require Express Scripts to stop reimbursing Arkansas pharmacy claims below the statutory floor and maintain an appeals process that complies with state requirements.1
The allegations have not been adjudicated, and the complaint represents the plaintiffs’ account of the dispute.2
Looking Ahead
For pharmacists and pharmacy operators, the case highlights the potential legal and financial implications of state PBM reimbursement requirements and the growing role of private enforcement mechanisms. The litigation could also provide additional clarity on how Arkansas's NADAC reimbursement floor and Act 990 apply to individual prescription claims and whether later payment adjustments affect liability for an initial alleged underpayment.
References
- Achor Family Pharmacy v Express Scripts, No. 26SL-CC06268 (Mo Cir Ct St Louis County filed Sept 15, 2026). Accessed September 23, 2026. https://dicellolevitt.com/wp-content/uploads/2026/09/Achor-Family-Pharmacy-et-al.-v.-Express-Scripts-%E2%80%93-Arkansas-Pharmacy-Reimbursement-Lawsuit-Complaint.pdf
- Bender E. Arkansas pharmacies sue Express Scripts over alleged underpayments. Healthcare Finance News. Published September 21, 2026. Accessed September 23, 2026. https://www.healthcarefinancenews.com/news/arkansas-pharmacies-sue-express-scripts-over-alleged-underpayments
