Florida Alleges Express Scripts, Prime Therapeutics Engaged in PBM Reimbursement Price-Fixing
Key Takeaways:
- Florida Attorney General James Uthmeier has sued Express Scripts and Prime Therapeutics, alleging that the competing pharmacy benefit managers (PBMs) entered into an unlawful agreement to coordinate reimbursement rates paid to retail pharmacies.1
- The state alleges Prime adopted lower Express Scripts reimbursement rates following a 2019 collaboration, with reimbursement subsequently declining for approximately 80% of branded drugs and 70% of generic drugs.1,2
- Express Scripts and Prime dispute the allegations, arguing that their arrangement is lawful and has generated savings while maintaining pharmacy access.2,3
Florida has filed an antitrust lawsuit against PBMs Express Scripts, Inc and Prime Therapeutics LLC, alleging that a collaboration between the competitors unlawfully suppressed reimbursement rates paid to retail pharmacies.1
The lawsuit, filed August 27, 2026, in the Circuit Court of the Tenth Judicial Circuit in Polk County, alleges that the companies engaged in horizontal price-fixing in violation of the Florida Antitrust Act and used unfair methods of competition in violation of the Florida Deceptive and Unfair Trade Practices Act.1
The companies dispute Florida's allegations. Express Scripts has said it reimburses network pharmacies fairly and intends to defend itself, while Prime maintains that its approach has lowered costs for patients, employers, and health plans while preserving broad pharmacy access.2,3
Florida Challenges 2019 PBM Collaboration
The dispute centers on a collaboration announced by Express Scripts and Prime in December 2019. Under the arrangement, Express Scripts agreed to provide Prime with certain services involving retail pharmacy networks and pharmaceutical manufacturer contracting.2
Florida alleges the agreement allowed Prime, which previously competed independently with Express Scripts for pharmacy network contracts, to adopt Express Scripts' lower pharmacy reimbursement rates when the arrangement took effect in April 2020.1,2
According to the state's complaint, Prime historically paid pharmacies approximately 20% more than the largest PBMs. After implementation of the agreement, Florida alleges reimbursement declined for approximately 80% of branded drugs and 70% of generic drugs.1
The state further alleges that Prime valued the first 3 years of the arrangement at approximately $2.5 billion in cost savings derived from reduced pharmacy reimbursements.1
These assertions remain allegations, and the court has not determined that Express Scripts or Prime violated antitrust or consumer protection laws.
State Alleges Horizontal Price-Fixing
The central legal question is whether the collaboration constitutes legitimate contracting between PBMs or unlawful coordination between competitors.
Florida characterizes the arrangement as horizontal price-fixing because Express Scripts and Prime allegedly competed in the market for pharmacy network services before agreeing to align aspects of their reimbursement practices.1
The state alleges the agreement reduced competition over the rates paid to pharmacies and allowed Prime to obtain reimbursement terms it may not have been able to negotiate independently.
Florida is seeking injunctive relief, civil penalties, disgorgement, damages, and other remedies.1
The case therefore represents a different regulatory challenge from many recent PBM disputes. Rather than focusing primarily on rebates, formulary placement, or vertical integration, Florida is applying traditional antitrust principles to the prices PBMs pay pharmacies.
PBMs Dispute Claims and Point to Cost Savings
Both defendants have rejected Florida's characterization of their relationship.
Express Scripts said it is committed to fairly reimbursing network pharmacies and described the allegations as baseless.2
Prime similarly argued that focusing solely on pharmacy reimbursement overlooks the effects that higher pharmacy costs may have on patients, employers, health plans, and taxpayers. The company said its model has produced savings while maintaining broad pharmacy access.3
That disagreement illustrates a central policy and compliance question underlying PBM regulation: whether negotiating leverage that lowers pharmacy reimbursement represents legitimate cost containment or crosses into anticompetitive coordination when exercised through agreements between otherwise competing PBMs.
Independent Pharmacy Reimbursement Takes Center Stage
Florida alleges that reduced reimbursement has forced some pharmacies to dispense medications below their acquisition costs.
The state's announcement cites a pharmacy outside Orlando whose reimbursement for one drug allegedly declined 45%, changing the transaction from a profit to a $15.45 loss per prescription.1
Florida argues that sustained below-cost reimbursement can threaten independent pharmacy viability and ultimately reduce patient access if pharmacies close or withdraw from PBM networks.1
The defendants dispute the broader implications of that argument. Prime maintains that its arrangements lower overall prescription drug costs while preserving access, highlighting the competing economic interests at the center of the litigation.3
The case could therefore provide an important test of how antitrust law applies to PBM contracting practices when arrangements produce lower reimbursement costs for purchasers but allegedly reduce competition among entities negotiating with pharmacies.
Lawsuit Adds to Growing PBM Antitrust Scrutiny
Florida's action is not the first legal challenge involving the Express Scripts-Prime relationship.
Independent pharmacies have previously filed litigation alleging that the companies' collaboration suppressed pharmacy reimbursement rates.2 Other states have also recently pursued antitrust claims involving PBMs, reflecting growing use of state competition laws to scrutinize pharmaceutical benefit administration and pharmacy reimbursement practices.4
The Florida case also comes amid broader federal scrutiny of PBM practices. The Federal Trade Commission has separately pursued proceedings involving major PBMs over alleged anticompetitive and unfair rebate practices affecting insulin pricing, although those proceedings involve different conduct and legal theories than Florida's reimbursement case.
Compliance Implications for PBMs and Pharmacy Networks
The lawsuit could have broader implications for PBMs that collaborate with competitors or outsource portions of their pharmacy network operations.
For PBMs and health plans, the case highlights potential antitrust considerations involving:
- competitor collaborations and joint contracting arrangements;
- sharing or adoption of pharmacy reimbursement methodologies;
- allocation of savings generated through contracting partnerships;
- documentation supporting the procompetitive rationale for collaborations; and
- the degree to which participating companies continue to make independent pricing and network decisions.
For pharmacies, the litigation could provide additional clarity regarding whether reimbursement arrangements negotiated through PBM partnerships are subject to traditional horizontal price-fixing theories.
The distinction will be important. Not every collaboration between competitors violates antitrust law, and arrangements that generate efficiencies can be lawful. Florida's case will require the court to assess the specific structure and effects of the Express Scripts-Prime relationship against the state's allegations that the companies improperly coordinated prices.
Looking Ahead
The Florida lawsuit represents another expansion of legal scrutiny surrounding PBMs, but its focus on alleged horizontal coordination makes it distinct from many recent state efforts centered on transparency, pharmacy ownership, or patient steering.
If the litigation proceeds, the court's treatment of the 2019 collaboration could provide important guidance for PBMs and other health care companies that enter partnerships with competitors to increase purchasing or negotiating leverage.
For PBMs, pharmacies, plan sponsors, and compliance professionals, the case reinforces the importance of evaluating competitor collaborations not only for their potential cost savings but also for whether pricing and reimbursement decisions remain sufficiently independent under applicable antitrust laws.
References
- Office of the Attorney General of Florida. Attorney General James Uthmeier takes legal action against Prime Therapeutics and Express Scripts for price-fixing scheme threatening Floridians' access to affordable medications. Published August 27, 2026. Accessed September 9, 2026. https://ebs.publicnow.com/view/EF9B90DAB95AE31C254C928818F72EBBFBE5A5C1
- Hughes J. Florida attorney general sues PBMs Express Scripts, Prime over alleged price fixing. Healthcare Dive. Published August 31, 2026. Accessed September 9, 2026. https://www.healthcaredive.com/news/florida-ag-sues-prime-express-scripts-price-fixing/829187/
- Minemyer P. Florida AG sues Prime Therapeutics, Express Scripts for alleged price-fixing. Fierce Healthcare. Published August 28, 2026. Accessed September 9, 2026. https://www.fiercehealthcare.com/payers/florida-ag-sues-prime-therapeutics-express-scripts-alleged-price-fixing
- Duane Morris LLP. State Attorneys General File Suit Against PBMs Based on Alleged Price-Fixing. Published September 3, 2026. Accessed September 9, 2026. https://www.duanemorris.com/alerts/state_attorneys_general_file_suit_against_pbms_based_alleged_price_fixing_0926.html
