Florida Sues Prime Therapeutics, Express Scripts Over Alleged Price Fixing

Florida Attorney General James Uthmeier announced the lawsuit Thursday in The Villages, according to FOX 35 Orlando. The state alleges the companies violated Florida antitrust and consumer-protection laws through an arrangement that lowered payments made to pharmacies for dispensing prescription medications.

The case adds to mounting scrutiny of pharmacy benefit managers, or PBMs, the intermediaries that negotiate drug benefits and determine reimbursement terms for pharmacies. Independent drugstores have increasingly argued that reimbursement practices can leave them dispensing some prescriptions at a loss.

Florida’s complaint alleges that Prime and Express Scripts reached an agreement in December 2019 under which Prime adopted lower reimbursement rates associated with Express Scripts. The arrangement took effect in April 2020, has since been extended several times and remains in place, according to the lawsuit as reported by FOX 35 Orlando.

The state alleges the changes produced steep reductions in pharmacy reimbursements. Payments for brand-name medications fell as much as 80%, while those for generic drugs declined as much as 70%, according to the complaint cited by FOX 35. Florida contends the resulting rates sometimes required local pharmacies to fill prescriptions for less than their costs.

We’d love to be your preferred source for news.

Please add us to your preferred sources list so our news, data and interviews show up in your feed. Thanks!

Add as Preferred Source

Uthmeier said the alleged conduct threatens both independent pharmacies and consumers who rely on them, particularly seniors and families. He accused the companies of coordinating prices and underpaying pharmacies, saying closures can leave patients with fewer options for obtaining medicines, according to FOX 35.

Prime disputed the state’s characterization. In a statement provided to FOX 35, the company said the lawsuit places too much emphasis on pharmacy profitability while failing to account for the costs ultimately borne by patients, employers, health plans and taxpayers. Prime said its approach has reduced consumers’ pharmacy-counter costs and generated savings while preserving broad pharmacy access.

Related: Prime Faces Federal Antitrust Suit Over Pharmacy Reimbursement Practices

Evernorth, the parent of Express Scripts, also rejected Florida’s claims. The company called the allegations baseless and said it reimburses pharmacies fairly and intends to defend itself vigorously, according to FOX 35.

Florida’s lawsuit includes claims of conspiracy in restraint of trade under the state’s antitrust law, conduct allegedly violating the Florida Deceptive and Unfair Trade Practices Act, and unjust enrichment. The attorney general is seeking an injunction, civil penalties, damages exceeding $50,000 and a jury trial, FOX 35 reported, citing the complaint.

The action follows broader pressure in Florida on the business practices of PBMs. Uthmeier’s office announced an investigation in June into CVS Health and its Caremark pharmacy-benefit operation over concerns involving competition, reimbursement practices and the treatment of independent pharmacies, according to a separate FOX 35 report.

The latest case shifts that scrutiny into litigation against two other major industry participants. Its outcome could help determine how far Florida can use state antitrust and consumer-protection statutes to challenge the reimbursement arrangements that sit between health plans, benefit managers and neighborhood pharmacies.

FOX 35 said its reporting was based on Uthmeier’s Aug. 27 announcement in The Villages, the lawsuit released afterward and responses the station obtained from Prime Therapeutics and Evernorth/Express Scripts.