Independent pharmacies sue Express Scripts over alleged violation of Arkansas PBM law
A dozen independent pharmacies in Arkansas filed a lawsuit this week, accusing Express Scripts of violating state pharmacy benefit manager (PBM) regulations that require pharmacies to be reimbursed for products at fair market rate.
In their complaint, the pharmacies accuse Express Scripts, owned by the insurer Cigna, of repaying them for prescription drugs that don’t even cover the costs of restocking. The plaintiffs claim this has happened “tens of thousands” of times, leaving them now seeking hundreds of thousands of dollars in damages.
Under a state law passed in 2025, PBMs are required to follow a minimum threshold for prescription drugs, as set by the National Average Drug Acquisition Cost (NADAC), a metric established by the Centers for Medicare & Medicaid Services.
As the lawsuit mentioned, within the NADAC is a full set of regulations that detail how much PBMs are required to pay to ensure pharmacies are not left unable to supply drugs, including details on how prices adjust based on the quantity of drugs, fill dates and more.
In Arkansas, if PBMs are found to reimburse at a rate below the payment floor, they can be fined $10,000 per violation, something the lawsuit seeks to have a court enforce.
Part of the challenge has been the clerical burden associated with documenting the inadequate reimbursement, something the independent pharmacies said has been an administrative burden, one that they believe Express Scripts relied on to continue their business practice of paying as little as possible.
As the plaintiffs note, NADAC standards are public, meaning all PBMs have access to the data and should be aware of the minimum reimbursement rates.
The pharmacies added that they have been forced to endure revenue shortfalls associated with underpayment, challenging their ability to remain independent and compete with larger chains. Dozens of drugs have been subject to under-reimbursement, according to the complaint.
“Whether a given shortfall is a few cents or many dollars, the statutory command is the same. And, 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,” the pharmacies wrote in their court filing.
The lawsuit was filed in a federal court in St. Louis, where Express Scripts is located.
Reducing the power of middle men
One of the “big three” PBMs, Express Scripts works with health plans to establish group buy rates for prescription drugs. But under Arkansas law, they are not allowed to pay smaller pharmacies less than larger organizations, and they must pass on manufacturer rebates consistently, so as not to unfairly control the drug supply market.
By their count, the pharmacies estimate that Express Scripts has underpaid them collectively for 48,300 prescriptions between August 2025 and March 2026, in violation of state law.
Express Scripts has yet to formally respond to the newly filed lawsuit. HealthExec reached out for comment.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.