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News
Twelve independent Arkansas pharmacies have filed a landmark lawsuit against Express Scripts, alleging the pharmacy benefit manager (PBM) illegally reimbursed them below drug acquisition costs tens of thousands of times. The suit — the first under a 2025 Arkansas law empowering pharmacies to sue PBMs — seeks hundreds of millions in damages. Express Scripts says it will defend itself against the allegations.
Twelve independent Arkansas pharmacies have filed what's believed to be the first lawsuit under a 2025 state law allowing pharmacies to sue pharmacy benefit managers (PBMs) for reimbursing them below the cost of acquiring drugs. The target: Express Scripts, one of the "Big Three" PBMs that collectively control 80% of U.S. prescriptions. The suit, filed in Missouri circuit court, seeks hundreds of millions of dollars in damages.
At the heart of the case is Arkansas' rule that PBMs must reimburse pharmacies at no less than the National Average Drug Acquisition Cost (NADAC) — a federally maintained benchmark. The pharmacies allege Express Scripts knowingly and repeatedly violated this rule, underpaying roughly 48,300 prescriptions between August 2025 and March 2026 alone. The complaint argues this isn't a technical glitch — it's a deliberate business strategy.
By the Numbers:
Why it matters: Independent pharmacies — already squeezed by PBM market power — are now using state law as a shield. This case could set a precedent for similar litigation across the country, intensifying pressure on PBMs at a time when federal regulation remains limited.
