Florida AG Sues Express Scripts and Prime Therapeutics Over Alleged Price Fixing

Florida's attorney general filed a lawsuit against pharmacy benefit managers Express Scripts and Prime Therapeutics, alleging that a business arrangement between the two companies depressed reimbursement rates paid to pharmacies in the state, according to Healthcare Dive, which reported the filing on August 31, 2026. A pharmacy benefit manager, or PBM, is a company that negotiates drug prices, builds formularies, and sets pharmacy reimbursement rates on behalf of insurers, employers, and Medicare Part D plans. The complaint claims the deal between the two PBMs suppressed what pharmacies were paid for dispensing prescriptions, though the reporting reviewed for this article did not detail specific dollar figures or the exact terms of the alleged arrangement.

Express Scripts operates under Cigna's Evernorth division, and Prime Therapeutics is a PBM formed and owned by a coalition of Blue Cross Blue Shield plans. Both companies rank among the largest PBMs in the country and process prescription claims for millions of Americans, including many enrolled in Medicare Part D and Medicare Advantage prescription drug plans. The lawsuit is a civil action brought by the state, and the allegations have not been proven in court. The source material reviewed for this article did not include a public response from Express Scripts or Prime Therapeutics, so it remains unclear how either company plans to address the claims.

This case is the latest in a string of state and federal actions targeting PBM business practices. According to Healthcare Dive's reporting, the Florida complaint is part of a broader pattern of legal challenges against the PBM industry, which has drawn scrutiny from lawmakers, the Federal Trade Commission, and multiple state attorneys general over how rebates, spread pricing, and reimbursement formulas are structured across the drug supply chain.

Key Takeaway

The Florida lawsuit targets a business dispute between two PBMs over pharmacy reimbursement, not a benefit change for Medicare enrollees. Still, PBMs like Express Scripts and Prime Therapeutics help set the pharmacy networks and cost structures behind many Part D and Medicare Advantage drug plans, so ongoing litigation in this space is worth watching if it eventually affects which pharmacies are in-network or how plans price prescriptions.

What This Means for Medicare Drug Coverage

Nothing in this lawsuit changes a current Medicare beneficiary's coverage, copays, or pharmacy access today. The case, as reported, centers on an alleged arrangement between two PBMs affecting reimbursement rates paid to pharmacies in Florida, not a direct claim against any Medicare plan or a specific Part D or Medicare Advantage insurer. However, PBMs play an outsized role in Medicare's prescription drug landscape: they build the drug formularies that determine which medications are covered and at what tier, negotiate the rebates that factor into plan pricing, and set the reimbursement rates that influence which pharmacies remain financially able to stay in a plan's network. When a state alleges that PBM practices have suppressed pharmacy reimbursement, it raises broader questions about the incentives built into the drug pricing system that Medicare plans rely on, even when the immediate legal dispute doesn't name a specific health plan.

Litigation like this can also be a signal of where regulatory attention is headed. If courts or regulators ultimately require changes to how PBMs negotiate with pharmacies, those changes could ripple into how Part D and Medicare Advantage drug benefits are priced or which local pharmacies participate in a plan's network in the future. That kind of shift wouldn't happen overnight, and it's too early to predict outcomes from a single state lawsuit, but it underscores why the PBM layer of Medicare's drug benefit system deserves ongoing attention from beneficiaries and the advisors who help them.

Practical Steps for Medicare Enrollees

Readers don't need to take any immediate action because of this lawsuit, but it's a good reminder to stay attentive to how PBM relationships can affect day-to-day coverage. A few practical steps can help:

Check your pharmacy network every year. PBM contracts and reimbursement disputes can occasionally lead to a pharmacy leaving a plan's preferred network, which changes what you pay at the counter. Reviewing your plan's pharmacy directory during Medicare's Annual Enrollment Period, which runs October 15 through December 7, is a simple way to confirm your preferred pharmacy is still covered at the best cost-sharing tier.

Compare Part D and Medicare Advantage drug costs annually. Formularies and pricing tiers, which are shaped in part by PBM negotiations, can change from one plan year to the next even if your health needs haven't. Using Medicare's official Plan Finder tool or working with a licensed insurance agent to re-run your specific medications each fall can catch cost changes before they hit your wallet.

Watch for follow-up coverage. If this lawsuit or similar PBM litigation elsewhere leads to settlements, regulatory rules, or documented changes to reimbursement practices, that's the point at which it could start to matter for specific plans or pharmacies. Medicare Plan Path will continue tracking developments in PBM oversight and will flag any changes that could affect Part D or Medicare Advantage drug benefits.

As always, beneficiaries with questions about how their current drug plan handles pharmacy costs, formulary tiers, or network pharmacies should consider speaking with a licensed Medicare agent, who can walk through plan-specific details that a general news update can't cover.