Florida Attorney General James Uthmeier has filed a lawsuit against Prime Therapeutics and Cigna’s Express Scripts, alleging the pharmacy benefit managers entered into an illegal horizontal price-fixing agreement that threatens access to affordable medications.
The lawsuit alleges the competitors entered a “collaboration” in December 2019 under which Prime, which is owned by BCBS plans, adopted Express Scripts’ significantly lower reimbursement rates, according to an Aug. 27 news release from the Florida attorney general’s office. The agreement took effect in April 2020 and remains in effect today.
Before the agreement, Prime’s reimbursement rates were roughly 20% higher. Afterward, reimbursement rates declined for around 80% of branded drugs and 70% of generic drugs. One pharmacy outside Orlando saw reimbursement for one drug fall 45%, resulting in a $15.45 loss per prescription.
Prime valued the first three years of the arrangement at $2.5 billion in “cost savings” extracted from pharmacies, according to the attorney general’s office.
The lawsuit alleges a per se violation of the Florida Antitrust Act as horizontal price-fixing and unfair methods of competition under the Florida Deceptive and Unfair Trade Practices Act. Mr. Uthmeier is seeking injunctive relief, civil penalties, disgorgement, damages and other remedies.
It’s the latest in a string of legal challenges over the same alleged arrangement. Nearly 5,000 independent pharmacies sued Prime in July, alleging the same 2019 price-fixing agreement with Express Scripts violated federal antitrust law, and an arbitrator ordered Prime to pay the AIDS Healthcare Foundation $10.3 million in a similar case in January.
In a statement to Becker’s, Prime Therapeutics said the complaint focuses on pharmacy profits while overlooking costs to patients, employers, health plans and taxpayers. The company said its approach has delivered “lower costs for patients at the pharmacy counter” while maintaining broad pharmacy access.
Becker’s also reached out to Express Scripts for comment and will update the story if a response is received.
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