Twelve independent pharmacies operating in Arkansas have initiated legal action against Express Scripts, contending that the pharmacy-benefit manager consistently paid them less than the minimum amounts mandated by state statutes. The suit, lodged on September 15 in the St. Louis County Circuit Court, alleges that Express Scripts issued reimbursements beneath the statutory floor on tens of thousands of occasions involving hundreds of different drugs.
Arkansas Law Sets Reimbursement Floor
The filing asserts that Express Scripts breached Arkansas Act 990, a law enacted in 2025 that bars PBMs from compensating pharmacies at rates below the pharmacies’ own acquisition costs. Those costs are determined by the National Average Drug Acquisition Cost (NADAC), a federal benchmark compiled weekly by the Centers for Medicare & Medicaid Services from a nationwide survey of retail pharmacy purchase prices. According to the complaint, Express Scripts possessed both the claim data and the up-to-date NADAC figures required to enforce the floor when processing each prescription, and its failure to do so was “not a technological challenge; it is a business decision.”
The plaintiffs are pursuing compensatory and statutory damages, as well as injunctive and declaratory relief, together with attorneys’ fees and related costs. While the complaint does not disclose a total monetary demand, Arkansas Act 990 provides a private right of action and permits damages of up to $10,000 per violation under the Arkansas Trade Practices Act.
Plaintiffs and Legal Strategy
The parties bringing the case include Achor Family Pharmacy, Brinkley Family Pharmacy, Buerkle Drug Management, Forrest City Family Pharmacy, Garner Family Pharmacy, Getwell Rx, McKenney Family Pharmacy, Nashville Family Pharmacy, Palestine Family Pharmacy, Polk Pharmacy Management doing business as Middleton Pharmacy, Redfield Pharmacy Management, and Woodlands Pharmacy Management. The suit was filed in Missouri because Express Scripts’ principal place of business lies in St. Louis County and its provider manual designates that county as the forum for contractual disputes. The filing notes that the pharmacies sent a notice to Express Scripts on June 23, offering a meeting to resolve the issue, but that the PBM failed to reply.
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Impact on Pharmacy Operations
The allegations remain untested in court, and the complaint presents the pharmacies’ perspective. “An independent pharmacy pays for its medicine before the patient ever walks through the door,” the suit states. Under Arkansas law, a PBM may not reimburse an Arkansas pharmacy less than the pharmacy’s cost of acquiring the drug itself, measured by the National Average Drug Acquisition Cost, the federal government’s drug-specific benchmark of what pharmacies pay to acquire each medicine. “NADAC is a floor beneath the ingredient cost. It is a minimum payment, not a suggestion, and not an after-the-fact appeal target,” the complaint adds.
When reimbursement falls below acquisition cost, pharmacies must absorb the difference after the medication has already been transferred to the patient. The plaintiffs argue that disputing individual payments imposes substantial administrative burdens: they must detect the underpayment, gather invoices, file an appeal, and track any correction. For minor shortfalls, the labor required can exceed the disputed amount, a situation that can strain pharmacies with limited cash reserves. Several of the named pharmacies serve rural areas where they may be the sole provider of prescription drugs and pharmacist services.
PBM Industry Under Scrutiny
Express Scripts, operating under the Evernorth brand of Cigna, responded to Healthcare Finance News through a spokesperson who said, “We’re committed to reimbursing pharmacies at competitive rates and will defend ourselves against these allegations.” At the same time, federal and state regulators are intensifying examination of PBM revenue models and pharmacy payment practices. A pending federal transparency rule would obligate PBMs to disclose to health plans additional details about their compensation, rebates, and other income streams. Moreover, PBMs are broadening their role in pharmacy services; Evernorth recently confirmed its complete ownership of CarepathRx, a company that delivers pharmacy and infusion services to hospitals and health systems.
