Twelve independent Arkansas pharmacies have sued Express Scripts, alleging the pharmacy-benefit manager reimbursed them below the minimum required by state law on tens of thousands of prescriptions. The complaint filed September 15 in federal court asks for damages, an injunction, attorney fees and a jury trial.
The case turns on Arkansas’ rules for the middlemen that administer prescription-drug benefits for insurers and employer health plans. The pharmacies say Express Scripts violated Act 900 of 2015, which regulates pharmacy-benefit managers’ maximum allowable cost lists and gives pharmacies a process to challenge reimbursements. The plaintiffs contend Arkansas law requires payment at least equal to the federal National Average Drug Acquisition Cost when that benchmark is available.
The filing does not establish that Express Scripts broke the law; those are allegations that must be tested in court. Arkansas Advocate reported that the company did not immediately respond to its request for comment. The pharmacies’ complaint says the alleged shortfalls were not isolated accounting errors but repeated transactions across many prescriptions.
The lawsuit is an early test of a newer enforcement path. Act 990 of 2025 created an express private right of action for pharmacies and permits statutory damages of as much as $10,000 per violation, in addition to other relief. That provision could make the number of disputed reimbursements central to the financial stakes, although the court will first have to decide whether the pharmacies prove each claimed violation.
The dispute arrives amid broader scrutiny of pharmacy-benefit managers. A Federal Trade Commission staff report said Express Scripts, CVS Caremark and OptumRx together processed roughly 79% of U.S. prescription claims for about 270 million people. The report described how consolidation can give large benefit managers significant leverage over independent pharmacies; the companies have disputed criticisms of their business practices and argue that they negotiate savings for health plans.
For Arkansas patients, the immediate practical effect is limited: the complaint does not change benefits, copayments or pharmacy hours by itself. The larger question is whether reimbursement levels make it harder for independent drugstores—especially those serving rural communities—to keep medicines in stock and remain open. Any injunction or damages award would require further court action, and no hearing schedule or merits ruling was announced with the filing.
The case therefore bears watching as both a pharmacy-payment dispute and a test of Arkansas’ attempt to let local pharmacies enforce state PBM rules directly. The next consequential filings should include Express Scripts’ response and any request to dismiss or narrow the claims.
Because the plaintiffs are individual pharmacies rather than the state, the case may also clarify how Act 990’s private remedy interacts with administrative oversight. The complaint asks the court to apply Arkansas reimbursement protections directly to the disputed claims; Express Scripts will have an opportunity to contest the pharmacies’ reading of the statutes, the transaction records and the requested damages.
