Antitrust Law Daily Wrap Up, ANTITRUST NEWS: Florida brings suit against two pharmacy benefit managers alleging price fixing, (Aug 28, 2026)

By Donielle Tigay Stutland, J.D.

The complaint alleges that the two competing pharmacy benefit managers had a years-long horizontal deal that locked pharmacies into lower reimbursement rates.

Florida Attorney General James Uthmeier announced the filing of a complaint against Prime Therapeutics LLC and Express Scripts, alleging that the two competing pharmacy benefit managers (“PBMs”) entered into an illegal horizontal price-fixing agreement. The complaint was filed in the in the in the Circuit Court of the Tenth Judicial Circuit in and for Polk County, and alleges that beginning in December 2019, the two competing PBMs announced a “collaboration” under which Prime adopted Express Scripts’ significantly lower reimbursement rates. The agreement took effect in April 2020, has been extended multiple times, and remains in effect today (Office Of The Attorney General v. Prime Therapeutics LLC, No. 255815859 (Fla. Cir. Aug. 27, 2026)).

“Floridians—especially our seniors and families—depend on local pharmacies for the medications that keep them healthy,” said Attorney General James Uthmeier. “Prime and Express Scripts colluded to fix prices and underpay those pharmacies, forcing many to fill prescriptions at a loss. When pharmacies struggle or close, patients lose local options and access to care. My office is holding them accountable to protect Florida patients.”

The lawsuit alleges a per se violation of the Florida Antitrust Act as horizontal price-fixing, as well as unfair methods of competition under the Florida Deceptive and Unfair Trade Practices Act (FDUTPA). The State brings claims alleging violations of the Florida Antitrust Act Chapter 542, FDUTPA Chapter 501 Part II, and common-law unjust enrichment)and seeks injunctive and declaratory relief, civil penalties, damages, disgorgement/restitution, fees, and costs.

Price fixing scheme. The complaint alleges that, “[u]nable to compete on the merits, Prime decided to do something about the higher reimbursement rates forced on it by lawful competition: execute an anticompetitive and illegal horizontal contract with ESI.” On December 19, 2019, the two PBMs “announced a new three-year collaboration,” where “[ESI] will provide services to Prime related to retail pharmacy network and pharmaceutical manufacturer contracts” (the “Agreement”). While seemingly innocuous, the State alleges that this “was a deceptive announcement of a horizontal price-fixing agreement between two competing PBMs.”

Under the Agreement, Prime fixed its reimbursement rates to match ESI’s and began reimbursing Prime’s network pharmacies at ESI’s lower reimbursement rates—making Prime’s business far more profitable overnight. In return, Prime shared with ESI a portion of the “savings” benefits Prime received plus the ability to add Prime’s covered lives to its own—thereby increasing even further ESI’s leverage over pharmacies to still lower reimbursements.

The suit alleges that the Agreement effectively eliminated competition between Prime and ESI for the procurement of pharmaceutical drug dispensing services from retail pharmacies and the reimbursement rate that Defendants offered to those retail pharmacies. Instead of competing with each other for healthcare plan sponsors, Prime and ESI agreed to distort that competition on the merits in their favor—to the detriment of the Florida’s retail pharmacies.

Prime followed up the Agreement announcement by sending a letter to pharmacies. The state indicates that the notice was short and vague notice, and did not provide pharmacies with a full account of the relevant details or ramifications of the Agreement. No reasonable network pharmacy would have known that the reimbursement rates and dispensing fees that the pharmacy previously negotiated with Prime (rather than ESI) would change based on reviewing this letter. The details that were omitted were substantive and failed to explain the true nature of the Agreement. Further, in the letter it was indicated that if a pharmacy had questions about their terms and conditions, “including reimbursement with ESI,” they should email an ESI email address. The State indicated that “single sentence provides insufficient notice to pharmacies of the imminent reimbursement rate consequences of the Agreement on retail pharmacies.”

Relevant Market. The complaint indicated that when an antitrust violation is per se illegal, it is unnecessary to define the relevant market(s) or allege market power. However, the State asserted in the alternative that “the Agreement still violates Florida antitrust laws under an alternative rule of reason analysis. Or to again quote the Prime Arbitration decision, the Agreement is “also an unreasonable restraint because,” among other things, “it undermined—even abandoned—the previously negotiated contract reimbursement rates between [pharmacies] and Prime.”

The relevant product market is the procurement of pharmacy dispensing services from retail pharmacies by PBMs (“Pharmacy Dispensing Services Market”). PBMs contract with retail pharmacies to secure the ability of members of an insurance plan to receive the benefit of their pharmacy coverage for prescription drugs from a retail pharmacy. PBMs process claims for the approximately 92% of Americans who have health insurance. The remainder of Americans without health insurance do not use a PBM, but rather purchase prescription drugs with cash. For retail pharmacies, cash-paying patients alone are not a reasonable substitute for the volume of commerce that flows through PBMs.

The relevant geographic market is the United States and an alternative geographic market is the State of Florida.

Agreement’s harms. The complaint alleges that an analysis of data for hundreds of pharmacies exemplifies the harm the parties’ Agreement has inflicted on pharmacies. Once the Agreement became effective, for around 80% of branded drugs, pharmacies saw their rates from Prime decline. Similarly, around 80% of branded drugs covered by Prime also saw their profitability go down. One example offered in the complaint was a pharmacy located outside Orlando which was reimbursed $60.85 per prescription for the drug Dilt-XR before the Agreement. But after the Agreement became effective, the reimbursement from Prime went down 45% to $34.16. Rather than producing a profit, every time the pharmacy chose to serve its Prime patients and dispense this drug, it would now lose $15.45. Similarly, a pharmacy in Jacksonville saw its profits from the drug Ellipta fall from $10.20 per prescription to a loss of $15.95.

The extent of the harms to these pharmacies is juxtaposed against the “cost savings” touted by Prime and ESI. Prime has valued the Agreement at $2.5 billion over the first three years. It has acknowledged “its $2.5 billion of cost savings that arose from the Collaboration—cost reductions that reflected the nationwide reduction of reimbursements to pharmacies.”

The Case is No. 255815859.

Attorneys: James Uthmeier, Attorney General, for the Office of the Attorney General.

Companies: Prime Therapeutics LLC; Express Scripts, Inc.

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