A group of twelve independent Arkansas pharmacies filed a federal lawsuit Tuesday against pharmacy benefit manager (PBM) Express Scripts, alleging the company unlawfully underpaid them for thousands of prescription medications. The plaintiffs accuse the St. Louis-based manager of violating Act 900, a state law passed in 2015 requiring PBMs to reimburse pharmacies at or above the national average drug acquisition cost.

Among the plaintiffs is a pharmacy owned by Republican State Representative Brandon Achor and his wife. The lawsuit alleges that pharmacies often had no choice but to absorb financial shortfalls caused by Express Scripts’ reimbursement practices, as denying or reversing claims would leave patients without critical medications.

Express Scripts, along with other major PBMs, serves as a middleman between drug manufacturers, distributors, pharmacies, and health insurers. The nation's three largest PBMs—Express Scripts, CVS Caremark, and OptumRx—collectively manage nearly 80% of prescription drug insurance claims for approximately 270 million Americans, according to a July 2024 Federal Trade Commission report. Express Scripts had not responded to requests for comment as of Tuesday afternoon.

Arkansas has been at the forefront of efforts to regulate PBMs. Act 900, upheld by the U.S. Supreme Court in 2020 as not being preempted by federal law, is part of a broader legislative push to protect patient access to medication and support independent pharmacies. Another law, Act 624 of 2025, sought to ban PBMs from also holding permits to operate drugstores, citing conflicts of interest. Express Scripts and other PBMs challenged the law, which was subsequently blocked by federal courts on commerce clause grounds. Arkansas is appealing the decision.

Further legislative measures, including Act 630 of 2025, aimed to limit drug manufacturers' control over which pharmacies can purchase their products. That law was also blocked by federal courts earlier this year, prompting the Arkansas State Board of Pharmacy to suspend enforcement in July.

In their lawsuit, the twelve pharmacies are seeking statutory damages of up to $10,000 per violation under the Arkansas Deceptive Trade Practices Act. They also request injunctive relief, a jury trial, and compensation for attorneys’ fees.

Separately, Arkansas Attorney General Tim Griffin has taken legal action against drug manufacturers and other entities for allegedly undermining a federal drug discount program designed to benefit healthcare providers treating vulnerable populations. In 2024, Griffin filed a suit against 22 defendants, accusing them of violating state law.

Arkansas regulators have also strengthened enforcement tools against PBMs. Last year, the Arkansas Insurance Department implemented a rule requiring PBMs to include dispensing fees when reimbursing pharmacies. A federal appeals court recently upheld the rule, allowing the state to continue enforcing it.

The case against Express Scripts follows mounting tensions between PBMs and independent pharmacies nationwide, as the latter struggle to remain financially viable under reimbursement practices they allege are unfair.