Express Scripts, the pharmacy benefit manager under Cigna’s Evernorth Health Services, filed a federal lawsuit June 12 against Tennessee officials regarding the state’s Freedom, Access and Integrity in Registered Pharmacy Act, also known as the FAIR Rx Act.
According to the law, beginning July 2028, Tennessee will not allow a company to have more than 5% ownership interest in a pharmacy as well as a health insurance issuer and pharmacy benefit manager. If a company meets this criteria, the pharmacy can continue operating through the end of 2028, but the pharmacy must show the state that it is planning a sale to a separate entity.
“If this misguided law takes effect, hundreds of thousands of patients could be left scrambling to navigate pharmacy closures and find new ways to access their medications and essential clinical support,” Susan Peppers, vice president of pharmacy practice for Evernorth, said in a June 12 news release.
Cigna claims the law unconstitutionally protects businesses from out-of-state competition and is preempted by TRICARE, Medicare Part D and the Employee Retirement Income Security Act. The company alleges more than 180,000 people in Tennessee rely on Express Scripts pharmacies. The company said it could also lose its specialized Accredo pharmacy operation in Memphis, which it said distributed 2.3 million prescriptions nationwide in 2025. The facility’s relocation could cost about $113 million and take 18 months.
CVS Health filed a lawsuit targeting the act in May. CVS and Express Scripts also sued over a similar Arkansas PBM law in May 2025. That law was enjoined, an action Express Scripts reiterated in its most recent complaint.
Becker’s contacted Tennessee’s attorney general and the state board of pharmacy, and will update this story if more information becomes available.
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