Arkansas pharmacies file lawsuit accusing PBM of underpaying them for medications

Twelve Arkansas pharmacies sued a pharmacy benefit manager in federal court Tuesday, alleging the company illegally underpaid them for tens of thousands of prescription medications.

The complaint accuses St. Louis-based Express Scripts of violating a 2015 law that requires pharmacy benefit managers, also known as PBMs, to pay pharmacies at least the national average of what drugstores pay wholesalers for drugs. The pharmacies that filed the suit include one run by Republican Rep. Brandon Achor and his wife. 

“The pharmacies had no practical choice but to absorb those shortfalls,” the complaint states. “Refusing or reversing a claim means turning away a patient who needs medicine.”

Pharmacy benefit managers negotiate prescription benefits among drug manufacturers, distributors, pharmacies and health insurance providers, and the biggest ones also own pharmacies and insurers.

Express Scripts is one of the nation’s three largest PBMs, along with CVS Caremark and OptumRX, and all three are owned by much larger corporations that each also own some of the nation’s largest health insurers. The three companies manage 79% of prescription drug insurance claims for approximately 270 million people, according to a July 2024 Federal Trade Commission report.

Express Scripts did not immediately respond to a request for comment Tuesday afternoon. 

The company is also among the five plaintiffs that sued Arkansas last year over its first-in-the-nation law banning PBMs from holding a permit to operate a drugstore. A federal judge blocked the law, saying it “likely violates” the U.S. Constitution’s commerce clause. The state appealed the ruling.

That law, Act 624, was one of several bipartisan 2025 measures the Legislature passed with the goal of increasing patients’ access to medication and helping independent pharmacies stay afloat amid PBM underpayments and competition from chain pharmacies.

Another one of those laws, Act 630, was also blocked in federal court in May. The Arkansas State Board of Pharmacy decided in July to not enforce the law, which would remove drugmakers’ power to limit which pharmacies can purchase their drugs.

The plaintiffs in Tuesday’s lawsuit cite another law that gives pharmacies the ability to sue PBMs that underpay them. The law entitles pharmacies to statutory damages of up to $10,000 per violation, in accordance with the Arkansas Deceptive Trade Practices Act.

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The plaintiffs also seek injunctive relief, a jury trial and payment of their attorneys’ fees.

Arkansas officials have taken several steps in the past few years to regulate pharmacy benefit managers. In 2024, a legislative panel approved an Arkansas Insurance Department rule requiring PBMs to include dispensing fees in their reimbursements to pharmacies for prescription drugs. A federal appeals court in August ruled that Arkansas can enforce this rule, upholding a dismissal of a legal challenge to the measure.

In July, Arkansas Attorney General Tim Griffin sued 22 defendants, including 13 drug manufacturers, alleging they violated the Arkansas Deceptive Trade Practices Act by undermining healthcare providers’ access to a federal drug discount program.