Five Arkansas Pharmacies Sue Express Scripts Over Alleged Underpayments

Five pharmacies serving communities in and around the Deltaplex are among 12 Arkansas independent pharmacies suing pharmacy benefit manager Express Scripts, alleging the company repeatedly reimbursed them below minimum amounts required under Arkansas law.

The area plaintiffs are Woodlands Pharmacy in White Hall, Redfield Pharmacy, Buerkle Drug in Stuttgart, Brinkley Family Pharmacy and Middleton Pharmacy in Clarendon.

At the center of the case are Arkansas requirements governing how pharmacy benefit managers, commonly known as PBMs, reimburse pharmacies for prescription drugs. The pharmacies allege Express Scripts repeatedly paid them less than the National Average Drug Acquisition Cost, or NADAC, which is used under Arkansas law as a minimum reimbursement benchmark.

According to the lawsuit, the 12 pharmacies estimate approximately 48,300 prescription claims were reimbursed below the required amount between August 2025 and the end of March 2026. The plaintiffs contend that figure could be conservative because they do not have complete access to Express Scripts’ claims-processing data.

The pharmacies allege the underpayments occurred across hundreds of medications and argue Express Scripts had the information needed to determine the applicable Arkansas reimbursement amount when processing the claims.

Those claims remain allegations. No court has determined that Express Scripts violated Arkansas law or established how many of the disputed transactions, if any, constitute violations.

Express Scripts has disputed the allegations, saying it is committed to reimbursing pharmacies at competitive rates and intends to defend itself against the lawsuit.

The case comes as Arkansas has increased its oversight of PBMs and pharmacy reimbursement practices. An August report from the Arkansas Insurance Department shows regulators had already scheduled an on-site examination of Express Scripts Administrators for September 7th through September 18th. That regulatory examination is separate from the pharmacies’ lawsuit, and the report does not indicate that the examination was prompted by the newly filed case.

The same report shows the department has recently taken enforcement action against several other PBMs for reimbursements below NADAC, including penalties against OptumRx, SavRx, TrueRx Management Services, Prime Therapeutics, ProCare Pharmacy Benefit Manager and LucyRx Health Solutions.

The pharmacies’ lawsuit also relies in part on a law Arkansas lawmakers enacted in 2025. Act 990 expressly allows pharmacies and pharmacists to bring private lawsuits over alleged violations of the state’s maximum allowable cost requirements and seek specified remedies.

The plaintiffs are seeking compensatory and statutory damages, attorneys’ fees and court orders requiring future compliance and the reprocessing of affected claims. Arkansas law allows statutory damages of up to $10,000 for each qualifying violation proven in court.

Attorneys representing the pharmacies say the potential statutory damages could reach hundreds of millions of dollars. However, no damages have been awarded, and the complaint does not provide individual claim totals or alleged losses for the five Deltaplex-area pharmacies.

The lawsuit remains pending in St. Louis County Circuit Court.

Five Arkansas Pharmacies Sue Express Scripts Over Alleged Underpayments

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