Nearly 5,000 independent pharmacies have filed an antitrust and breach-of-contract lawsuit against Prime Therapeutics, LLC, alleging the pharmacy benefit manager conspired with Cigna Inc.’s (NYSE:CI) Express Scripts to suppress pharmacy reimbursement rates and increase fees.
Pharmacies Allege Arbitration Delays Blocked Legal Claims
According to the complaint, TRUST LLC, a Virginia limited liability company formed in 2023 by the National Community Pharmacists Association, represents nearly 5,000 independent pharmacies that assigned their claims to the organization.
The lawsuit states that Prime introduced a mandatory arbitration amendment to its Pharmacy Participation Agreements, effective December 1, 2024, requiring disputes to be resolved before JAMS.
Bloomberg Law published a copy of the lawsuit online last week.
TRUST LLC says it complied with that requirement by filing a demand for arbitration in October 2025 and subsequently provided Prime with assignment documentation for participating pharmacies.
However, the complaint alleges Prime later argued that many pharmacies were not subject to the JAMS provision and instead should proceed before the American Arbitration Association (AAA), without identifying which pharmacies were affected.
After TRUST LLC filed an arbitration demand with the AAA in April 2026, the lawsuit alleges Prime indicated it would challenge that forum as well. The plaintiffs contend Prime refused to commit to any dispute resolution process, effectively preventing pharmacies from pursuing their claims despite imposing mandatory arbitration provisions.
Antitrust Claims Center On Alleged 2019 Agreement
The lawsuit alleges that Prime entered into a price-fixing agreement with Express Scripts in 2019 that enabled Prime to reduce reimbursement rates paid to pharmacies while increasing various fees, including direct and indirect remuneration fees and transaction fees.
According to the complaint, the plaintiffs claim the agreement allowed Prime to match Express Scripts’ reimbursement rates and fee structure by sharing confidential pricing information, eliminating normal competitive market forces.
The pharmacies argue that Prime, which allegedly lacks Express Scripts’ market power on its own, used the agreement to impose less favorable payment terms than would otherwise have existed in a competitive market.
Plaintiffs Allege Contract And Antitrust Violations
The complaint further alleges that Prime’s reimbursement reductions and fee increases violated the terms of its contracts with participating pharmacies.
The plaintiffs contend the alleged arrangement constitutes both a per se unlawful restraint of trade and a Rule of Reason violation under the Sherman Antitrust Act because it allegedly reduced competition while enabling Prime and Express Scripts to extract higher revenues at pharmacies’ expense.
The lawsuit seeks damages under federal antitrust law as well as compensation for the alleged breach of contract.
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