Nearly 5,000 independent pharmacies are suing pharmacy benefit manager Prime Therapeutics, alleging it colluded with rival Express Scripts to fix drug reimbursement rates and inflate fees. The lawsuit, filed July 2 in Washington federal court, claims a 2019 agreement between the two PBMs allowed Prime to adopt Express Scripts' lower reimbursement rates — squeezing independent pharmacies while boosting PBM revenues.
Nearly 5,000 independent pharmacies are taking on pharmacy benefit manager (PBM) Prime Therapeutics in a new antitrust lawsuit, alleging the company teamed up with Express Scripts to rig drug reimbursement rates against them. Filed July 2 in Washington federal court by TRUST, LLC — an organization backed by the National Community Pharmacy Association — the suit claims a 2019 agreement between the two PBMs allowed Prime to effectively "rent" Express Scripts' market power to impose lower reimbursement rates and higher fees on independent pharmacies.
The pharmacies argue that under the deal, Prime adjusted its own rates to mirror Express Scripts' less favorable terms, boosting PBM revenues at the expense of smaller pharmacy operators. Notably, Express Scripts is not named as a defendant despite being central to the allegations.
Key Takeaways:
Why it matters: Independent pharmacies have long battled PBMs over opaque fee structures and reimbursement rates. This case could set a significant precedent for how PBM partnerships are scrutinized under antitrust law — with real implications for drug pricing and pharmacy access across the U.S.
