By The Epoch Times | Created at 2026-09-18 16:55:00 | Updated at 2026-09-18 23:15:17
6 hours ago
A dozen independent Arkansas pharmacies have filed a lawsuit against pharmacy benefit manager Express Scripts, alleging that it paid them less than the cost of prescription drugs.
Under Arkansas law, a pharmacy benefit manager may not reimburse a pharmacy less than what it paid for the drug.
The pharmacies estimated that Express Scripts reimbursed less than the actual drug cost at least 48,300 times between August 2025 and March 2026, according to the Sept. 15 lawsuit. Achor Family Pharmacy, owned by state Rep. Brandon Achor, is one of the plaintiffs.
According to the lawsuit, the Centers for Medicare and Medicaid Services publishes National Average Drug Acquisition Cost data every week. That includes the drug cost, quantity, and fill date—everything a benefit manager needs to calculate a minimum payment for pharmacies.
“Express Scripts’ failure to comply with Arkansas law is not a technological challenge; it is a business decision,” the complaint alleges. “Express Scripts repeatedly chose to violate Arkansas law.”
The pharmacies said in the claim that Express Scripts’s underpayments forced them to absorb the loss.
Express Scripts did not respond to The Epoch Times’ request for comments by the time of publication.
Express Scripts, owned by Cigna and headquartered in St. Louis, is one of the big three pharmacy management companies, along with UnitedHealth Group’s OptumRx and CVS Caremark.
Together, the three managed 79 percent of prescription drug claims for about 270 million Americans in 2023, according to the Federal Trade Commission.
Pharmacy benefit managers, mostly owned by large insurance companies, are the middlemen between drug manufacturers, pharmacies, and insurers. They exercise control over drug pricing and which drugs an insurance company will cover.
In 2025, Arkansas passed an amendment allowing pharmacies to sue benefit managers for violating maximum allowable cost and reimbursement laws. It can yield statutory damages of up to $10,000 per violation, among other remedies.
“Whether a given shortfall is a few cents or many dollars, the statutory command is the same,” the complaint reads. “Repeated thousands of times, the shortfalls become a recurring withdrawal from the pharmacy’s operating account: the cash needed to buy insulin, antibiotics, anticoagulants, seizure medications, cancer drugs, and the next patient’s prescription.”
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Pharmacy managers emerged in the 1960s, when U.S. insurers began integrating prescription drug coverage into their plans. They were created to help insurers control spending and manage benefits.
In recent years, rising prescription drug prices intensified scrutiny of alleged unfair practices among benefit managers.
In February, the Federal Trade Commission secured a landmark settlement with Express Scripts. The underlying lawsuit alleged that the benefit manager inflated list prices for insulin drugs through anticompetitive and unfair rebating practices, thereby impairing patients’ access to lower-list-price products.
The settlement requires Express Scripts to overhaul its business practices to increase transparency. The company’s changes are expected to drive down patients’ out-of-pocket costs for insulin and other drugs by up to $7 billion over 10 years, bring millions of dollars in revenue to community pharmacies each year, and advance the Trump administration’s key healthcare priorities.
In July 2025, the House of Representatives introduced the bipartisan “Pharmacy Benefit Manager Reform Act of 2025” to improve transparency, restrict abusive rebate practices, and boost competition in the prescription drug supply chain.
Manufacturers pay undisclosed rebates to pharmacy benefit managers in exchange for placing a drug on an insurer’s covered drug list, thereby increasing list prices, according to The Commonwealth Fund, a private foundation focused on healthcare. While most rebates went to insurers, patients’ premiums and cost-sharing are not reducing.
“As [pharmacy benefit managers] increasingly act in their own self-interest without transparency or accountability, drug prices rise and patients face health risks from cost-prohibitive drug treatments,” Dr. Bobby Mukkamala, a past president of the American Medical Association, said in a 2025 statement.
