Florida has sued two of the biggest pharmacy-benefit managers (PBMs) — Express Scripts and Prime Therapeutics — alleging the rivals illegally coordinated to fix prices in a way that squeezed the pharmacies that dispense drugs.
PBMs are the powerful middlemen that negotiate drug prices and set pharmacy reimbursement between insurers, drugmakers and pharmacies. Florida Attorney General James Uthmeier filed the suit in state court, centering on a 2019 agreement in which Express Scripts began providing pharmacy-networking and drugmaker-contracting services to Prime. That arrangement, the complaint alleges, let Prime lower its reimbursement rates to match Express Scripts’ — depressing payments to Florida pharmacies.
The claims
According to the complaint, reimbursement rates on some drugs dropped as much as 80% for certain Florida pharmacies. Express Scripts covers roughly 1 in 3 Americans, giving it leverage to demand lower rates; Prime had previously offered rates about 20% higher to stay competitive. The suit alleges violations of Florida’s antitrust and unfair-trade-practices laws.
Why it matters
PBMs are under intense scrutiny nationwide over their opaque role in drug pricing, and this arrangement has drawn earlier challenges — a Wisconsin class action (later dismissed) and a suit last month by nearly 5,000 independent pharmacies. Prime defended the partnership, saying “savings generated by PBMs ultimately trickle down to patients”; Express Scripts didn’t comment by publication. The case adds to mounting legal and political pressure on the PBM business model.