Express Scripts already settled with the FTC for rigging insulin prices.
Now Florida's AG just uncovered what that settlement was designed to hide.
And Florida’s Attorney General just caught two drug middlemen stealing more than $2 billion from pharmacies.
What These Middlemen Actually Did
Prime Therapeutics and Express Scripts are competitors.
They're supposed to compete.
Instead, in December 2019 they called it a "collaboration" – and Prime quietly adopted Express Scripts' lower reimbursement rates across the board.
Translation: two rivals secretly agreed to pay your pharmacist less.
The deal went live in April 2020 and has been extended multiple times since.
https://twitter.com/AGJamesUthmeier/status/2092990789324300346?s=20
Florida Attorney General James Uthmeier filed suit Thursday, calling it exactly what it is – an illegal horizontal price-fixing scheme that violates Florida's Antitrust Act and the Florida Deceptive and Unfair Trade Practices Act.
"Prime and Express Scripts colluded to fix prices and underpay those pharmacies, forcing many to fill prescriptions at a loss," Uthmeier said.
“Floridians — especially our seniors and families — depend on local pharmacies for the medications that keep them healthy. Prime and Express Scripts colluded to fix prices and underpay those pharmacies, forcing many to fill prescriptions at a loss,” Uthmeier added. “When pharmacies struggle or close, patients lose local options and access to care. My office is holding them accountable to protect Florida patients.”
The Numbers Tell the Story
Before the deal, Prime's reimbursement rates ran roughly 20% higher than Express Scripts'.
After the deal, reimbursement rates fell for 80% of brand-name drugs and 70% of generic drugs.
One pharmacy outside Orlando watched its reimbursement for a single medication collapse by 45%.
That turned a profitable prescription into a $15.45 loss – every single time the prescription was filled.
https://twitter.com/AGJamesUthmeier/status/2092978861843873819?s=20
Prime quietly valued the first three years of this arrangement at $2.5 billion in "cost savings."
They didn't save a dime.
They took it straight from your neighborhood pharmacist.
This Is Not a One-State Problem
Uthmeier announced the lawsuit at The Villages – and that wasn't an accident.
He was standing in front of the exact audience getting hurt: seniors who depend on local pharmacies for their daily medications.
This is the same Express Scripts the FTC sued in 2024 for artificially inflating insulin prices through rebating schemes that pushed costs onto patients.
Express Scripts already settled that case in February 2026.
The settlement wasn't enough to stop them.
Since Congress failed to pass PBM reform in late 2024, more than 326 pharmacy storefronts have closed – 237 of them independent pharmacies – in fewer than ten weeks alone.
Nationally, about ten percent of independent rural pharmacies closed between 2013 and 2022.
https://twitter.com/FLVoiceNews/status/2092983963434254690?s=20
The math is simple: when middlemen rig the rates, local pharmacies fill prescriptions at a loss, and eventually they close.
When the local pharmacy closes, your 80-year-old mother drives 40 miles for her blood pressure medication.
Why Uthmeier's Move Matters
Florida isn't done.
The AG's office already issued a civil investigative demand to CVS Health in June, probing whether its practices are contributing to pharmacy closures in Florida.
That investigation is still active.
This week's lawsuit is part of a broader fight – Florida using its own antitrust laws to go after the corporate middlemen Biden let run loose for four years.
Uthmeier is seeking an injunction to stop the scheme cold, plus civil penalties, disgorgement of those $2.5 billion in extracted "savings," and damages for every Florida pharmacy that filled prescriptions at a loss.
The era of unchecked PBM abuse – Uthmeier's words – is over in Florida.
Sources:
- Florida Attorney General James Uthmeier, Official Statement, MyFloridaLegal.com, August 27, 2026.
- "Florida AG sues Prime and ESI," National Community Pharmacists Association, August 28, 2026.
- "Florida Attorney General sues pharmacy benefit management companies, alleges price-fixing agreement," Fox 13 Tampa Bay, August 27, 2026.
- "Florida AG sues Express Scripts and Prime Therapeutics over reimbursement cuts," WFTV Channel 9 Orlando, August 27, 2026.
- "Over 300 Pharmacy Closures Reported in the Last 3 Months," Drug Topics, August 2026.
- Federal Trade Commission, Pharmacy Benefit Managers Staff Report, FTC.gov.
