Florida's attorney general has filed an antitrust lawsuit accusing two of the country's largest pharmacy benefit managers of secretly coordinating prices in a way that forced independent pharmacies across the state to fill everyday prescriptions at a loss. The suit, brought against Express Scripts and Prime Therapeutics, centers on a December 2019 collaboration agreement that took effect in April 2020 and, according to the state, remains in place today.
Attorney General James Uthmeier filed the case in the Circuit Court of the Tenth Judicial Circuit in Polk County, alleging that Prime and Express Scripts colluded to fix prices and underpay local pharmacies, as reported by the Tampa Free Press. Uthmeier said pharmacy struggles or closures can reduce patients' local options and access to care. Express Scripts, Inc. and Prime Therapeutics LLC are both identified in the filing as pharmacy benefit managers, or PBMs, the industry middlemen that negotiate drug prices and reimbursements between insurers, drug makers and pharmacies.
How the Deal Allegedly Squeezed Pharmacies
Before the agreement, Prime Therapeutics reportedly paid independent pharmacies reimbursement rates roughly 20% higher than larger competitors like Express Scripts. The 2019 arrangement changed that dynamic: Prime agreed to adopt Express Scripts' lower retail reimbursement payment models and network pricing rules, and the two companies established joint pricing guardrails, minimums, maximums and annual true-up financial payments, according to the lawsuit. The agreement is alleged to have cut payment rates for about 80% of brand-name prescriptions and 70% of generic drugs.
The financial fallout, as described in the filing, hit pharmacies across the state. A pharmacy in St. Cloud filled pregabalin and took a $10.31 loss per prescription after reimbursements for the drug fell 80%. Outside Orlando, a pharmacy dispensing Dilt-XR saw reimbursements drop 45%, generating a $15.45 loss per fill. In Jacksonville, a pharmacy that dispensed the asthma medication Ellipta watched its profit on the drug swing from a positive $10.20 per prescription to a $15.95 loss.
Leesburg Pharmacy Among Those Cited
A pharmacy in Leesburg dispensed levothyroxine and saw reimbursements drop 22%, a reduction the lawsuit says caused a 70% decline in profitability on that drug. The same Leesburg pharmacy also had its reimbursement for levetiracetam cut by 30%, according to the filing. Prime Therapeutics holds roughly 40% market share in Florida, giving the alleged pricing scheme broad reach across the state's independent pharmacy network.
The lawsuit brings multiple claims, including per se horizontal price-fixing under the Florida Antitrust Act, unfair competition under the Florida Deceptive and Unfair Trade Practices Act, and common-law unjust enrichment. The attorney general's office is seeking actual damages, treble damages under state antitrust statutes, civil penalties, disgorgement of profits and permanent injunctive relief, and has demanded a jury trial.
PBMs Defend the Deal's Savings
Prime Therapeutics has estimated, according to court filings, that the arrangement generated $2.5 billion in nationwide cost savings over its first three years. Former Prime CEO Ken Paulus has remarked that the deal had been worth every penny. That defense — that network collaboration lowered drug acquisition costs for health plans and employers — sits at the center of the industry's pushback against regulators and independent pharmacists, who counter that those savings came directly out of local dispensaries' margins, as the Tampa Free Press reported.
Florida is far from alone in targeting this specific agreement. An American Arbitration Association arbitrator found in January 2025 that Prime Therapeutics was liable for illegal horizontal price-fixing with Express Scripts, ordering the company to pay over $10.3 million in treble damages to the AIDS Healthcare Foundation, according to Fierce Healthcare. Michigan Attorney General Dana Nessel filed her own federal antitrust suit against the two companies in April 2025, alleging the same 2019 deal created pharmacy deserts in half of Detroit's neighborhoods, with Express Scripts allegedly controlling up to 89% of the state's PBM market. In July 2026, TRUST LLC, an organization representing nearly 5,000 independent pharmacies formed by the National Community Pharmacists Association, filed a federal antitrust lawsuit in Washington against both companies over the same agreement.
A Pattern of Legislative and Regulatory Pressure
Florida had already tried to rein in PBM pricing practices through legislation. Senate Bill 1550, the Prescription Drug Reform Act, took effect in May 2023 and banned PBM spread pricing, required 100% pass-through of drug rebates, and mandated that PBMs operating in the state hold administrator licenses from the Florida Office of Insurance Regulation by 2024, with daily fines of up to $10,000 for unlicensed operators. The new lawsuit seeks judicial remedies for losses the state says local dispensaries already suffered before those reforms could take full effect.
The case also lands amid broader federal scrutiny of the PBM industry. The Federal Trade Commission filed an administrative antitrust suit in September 2024 against Express Scripts, CVS Caremark and OptumRx over inflated drug list prices, leading to proposed settlements with Express Scripts and CVS Caremark earlier this year. A separate FTC staff report from January 2025 found that top PBMs marked up specialty generic drugs by hundreds to thousands of percent at their own affiliated pharmacies while squeezing payments to unaffiliated community pharmacies, generating more than $7.3 billion in revenue above estimated acquisition costs. Industry data from the Drug Channels Institute, cited by Becker's Hospital Review, found that Express Scripts, CVS Caremark and OptumRx together processed 80% of equivalent U.S. prescription claims in 2025, with Prime Therapeutics adding another 3%.
The pressure on independent pharmacies described in the lawsuit mirrors a national trend. National Community Pharmacists Association data released in October 2025 showed the number of independent U.S. community pharmacies had fallen to 18,960 by July of that year, with owners reporting 10-year lows in gross profit margins despite filling record prescription volumes. Prime Therapeutics operates a specialty pharmacy operations center in Orlando that employs care specialists and pharmacists supporting more than 30 disease categories, and the company serves over 2 million Floridians through health plans — giving the Florida case added local weight even as the company continues to win business elsewhere, including a Medicaid contract in North Carolina reported in Prime's NC Medicaid deal.
Express Scripts is also fending off litigation on other fronts. Charter Communications sued the company in St. Louis in April, seeking millions in allegedly withheld drug rebates from claims filed between 2020 and 2022, according to Hoodline's earlier reporting on the rebate dispute in St. Louis. Taken together, the arbitration award, the Michigan and Florida lawsuits, the pharmacy trade group's federal case and the FTC's ongoing enforcement push paint a picture of a single 2019 pricing agreement now facing challenges from nearly every direction — regulators, competitors and the pharmacies caught in the middle.
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