The Florida Office of the Attorney General has filed an antitrust lawsuit against two of the nation’s largest pharmacy benefit managers, Express Scripts, Inc. and Prime Therapeutics LLC, accusing them of coordinating an illegal price-fixing scheme that sharply reduced reimbursements to local pharmacies across the state.
The civil complaint, filed Thursday morning in the Circuit Court of the Tenth Judicial Circuit in Polk County, targets a December 2019 collaboration agreement between the two direct competitors.
Under that deal, which took effect in April 2020 and has been extended through the present, Prime agreed to adopt Express Scripts’ lower retail reimbursement payment models and network pricing rules.
According to court filings, Prime—the largest pharmacy benefit manager in Florida with roughly 40% market share—previously paid independent pharmacies reimbursement rates that were about 20% higher than larger competitors like Express Scripts.
Following the agreement, payment rates dropped for approximately 80% of brand-name prescriptions and 70% of generic drugs, forcing independent dispensers to fill common medications at steep financial losses.
State regulators cited specific local examples in the complaint:
Outside Orlando, a pharmacy filling the blood pressure drug Dilt-XR saw reimbursements drop 45%, converting normal operations into a $15.45 loss per fill.
In St. Cloud, reimbursements for the nerve medication Pregabalin fell by 80%, resulting in a $10.31 loss per prescription.
In Jacksonville, profits on the inhaler Ellipta swung from a positive $10.20 per prescription to a $15.95 loss.
In Leesburg, reimbursements for the thyroid drug levothyroxine dropped 22%, driving a 70% decline in profitability, alongside a 30% cut for the seizure medication levetiracetam.
The state alleges the two companies established joint pricing guardrails, minimums, maximums, and annual “true-up” financial payments to enforce rate parity. Prime estimated the arrangement generated $2.5 billion in nationwide “cost savings” over its first three years by lowering provider payouts, with former Prime CEO Ken Paulus later remarking that the deal had “been worth every penny.”
“Floridians—especially our seniors and families—depend on local pharmacies for the medications that keep them healthy,” Attorney General James Uthmeier said in a statement. “Prime and Express Scripts colluded to fix prices and underpay those pharmacies, forcing many to fill prescriptions at a loss. When pharmacies struggle or close, patients lose local options and access to care. My office is holding them accountable to protect Florida patients.”
The lawsuit alleges per se horizontal price-fixing under the Florida Antitrust Act, unfair competition under the Florida Deceptive and Unfair Trade Practices Act, and common-law unjust enrichment. The state has demanded a jury trial, seeking permanent injunctive relief, civil penalties, actual damages, treble damages under state antitrust statutes, and the disgorgement of profits.
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