Florida PBM Lawsuit: Prime and Express Scripts Sued

Updated August 28, 2026

The Florida PBM lawsuit filed August 27 accuses Prime Therapeutics and Express Scripts of coordinating reimbursement rates paid to pharmacies. Florida alleges the arrangement harmed independent pharmacies and threatened local prescription access. The companies dispute the claims. No court has found either defendant liable, and no patient refund or immediate change to copays has been announced.

What Happened

Florida Attorney General James Uthmeier sued Prime Therapeutics LLC and Express Scripts, Inc., two pharmacy benefit managers, or PBMs. The Florida attorney general’s August 27 announcement says the companies coordinated pharmacy reimbursement through a collaboration announced in December 2019.

PBMs administer prescription benefits for health plans. They negotiate with drugmakers, create pharmacy networks, process claims and determine how much pharmacies receive for covered prescriptions. The FTC’s pharmacy benefit manager report explains how these middlemen can influence drug access, pharmacy choice and costs.

What the Florida PBM Lawsuit Alleges

Florida alleges that Prime and Express Scripts were competitors when they entered the collaboration. Under the state’s account, Prime adopted Express Scripts’ lower reimbursement models and network pricing rules beginning in April 2020. The agreement was extended.

The complaint asserts three claims: conspiracy in restraint of trade under the Florida Antitrust Act, conduct covered by the Florida Deceptive and Unfair Trade Practices Act before January 1, 2024, and unjust enrichment.

The state argues that coordinated reimbursement removed competition between the PBMs and forced some independent pharmacies to fill prescriptions at a loss. That is the government’s allegation. It has not been established at trial.

The 80% and 70% Figures Need Careful Reading

The official release says reimbursement rates declined for around 80% of branded drugs and 70% of generic drugs. It does not say every affected reimbursement rate fell by 80% or 70%.

Those figures describe the share of medicines allegedly receiving lower reimbursement. They do not establish the average size of each reduction. Without drug-level data, readers should not convert them into a universal percentage cut.

Prime and Express Scripts Dispute the Claims

Prime said the complaint focuses on pharmacy profits while overlooking costs paid by patients, employers, health plans and taxpayers. The company said its approach reduced patient costs and maintained broad pharmacy access.

Evernorth, the parent organization of Express Scripts, called the allegations baseless and said the company reimburses network pharmacies fairly. The responses were reported in FOX 35’s coverage of the Florida filing.

What This Could Mean for Patients

The immediate dispute concerns money paid to pharmacies, not the amount a patient pays at the counter. Those figures are related but are not identical.

A pharmacy’s reimbursement can include the patient’s copay plus the amount paid by the plan or PBM. A pharmacy may argue that the total is below its acquisition and dispensing costs even when the patient’s copay stays unchanged. Conversely, a higher pharmacy reimbursement does not automatically produce a lower copay.

Florida’s consumer theory is indirect: if local pharmacies repeatedly lose money on prescriptions, some may reduce services, leave networks or close. That could limit nearby options, particularly for seniors, rural residents and people who need regular medications. The lawsuit does not prove those outcomes occurred because of this agreement.

What Has Not Changed

No judge has ordered Prime or Express Scripts to change reimbursement, restore a pharmacy to a network or pay consumers. Coverage, formularies, copays and preferred-pharmacy rules remain governed by each health plan.

The complaint reportedly seeks damages exceeding $50,000, along with penalties and injunctive relief. That does not value the case at $50,000. Florida circuit courts generally hear civil disputes above that jurisdictional threshold, as the Florida Courts system explains.

What Florida Patients Should Do Now

1. Do not stop or change medication because of the lawsuit. Discuss treatment changes with the prescribing clinician.
2. Verify the pharmacy before each important refill. Ask the health plan and pharmacy whether the location remains in network and preferred.
3. Compare the complete price. Ask about the insurance price, available cash price and an approved generic or alternative when appropriate.
4. Save records. Keep receipts, claim rejections, transfer notices, explanations of benefits and plan communications.
5. For Medicare coverage, compare pharmacies carefully. The official Medicare Plan Compare tool can show estimated drug costs at different pharmacies.

Official Complaint and Assistance Resources

Florida consumers with a health-insurance or prescription-benefit issue can request help through the Florida Department of Financial Services consumer assistance service. General allegations of unfair or deceptive business conduct may be submitted through the Florida attorney general’s consumer complaint form.

Pharmacies have a separate Florida PBM complaint resource. Filing a complaint does not guarantee reimbursement, damages or participation in the state’s lawsuit.

Bottom Line

The Florida PBM lawsuit alleges that Prime and Express Scripts coordinated pharmacy reimbursement instead of competing. The companies deny wrongdoing, and the case remains pending. Patients should expect no immediate payment or benefit change, but they can document access problems, confirm network status and use official complaint channels when a prescription issue cannot be resolved.

Editorial disclaimer: This article provides general consumer information and is not legal, medical, insurance or financial advice. Coverage, pharmacy access, complaint rights and possible relief depend on the plan, facts and court proceedings.