Florida Attorney General James Uthmeier has filed suit against two of the nation’s largest pharmacy benefit managers, accusing them of striking a secret pricing deal that gutted reimbursements to local pharmacies and left Floridians with fewer places to get their prescriptions filled.

The lawsuit, filed against Prime Therapeutics LLC and Express Scripts, Inc., alleges the companies entered an “illegal horizontal price-fixing agreement” in December 2019 — an arrangement the state says has quietly persisted, and been extended, ever since. It’s the kind of behind-closed-doors corporate consolidation that free-market conservatives have long warned distorts healthcare pricing far more than government regulation does.

According to the complaint, Prime agreed to adopt Express Scripts’ lower reimbursement rates starting in April 2020. The result, prosecutors say, was reimbursement cuts of roughly 80% for brand-name drugs and 70% for generics — rates so low that some independent pharmacies were filling prescriptions at a loss.

The state has brought three counts: conspiracy in restraint of trade under Florida’s Antitrust Act, violation of the state’s Deceptive and Unfair Trade Practices Act, and unjust enrichment. Uthmeier is seeking injunctive relief, civil penalties, damages exceeding $50,000, and a jury trial.

“Prime and Express Scripts colluded to fix prices and underpay those pharmacies, forcing many to fill prescriptions at a loss,” Uthmeier said in a statement. “When pharmacies struggle or close, patients lose local options and access to care.”

The case underscores a point conservatives have made for years: the losers in a consolidated, opaque pharmacy-benefit industry are often the small, independent businesses on Main Street — not the sprawling corporate intermediaries that increasingly control drug pricing behind the scenes. Independent pharmacies operate on thin margins to begin with, and losing money on every prescription filled is not a business model that survives.

Prime Therapeutics pushed back, arguing the complaint “focuses on pharmacy profits but overlooks the impact that higher pharmacy costs have on the patients, employers, health plans and taxpayers who ultimately pay for prescription drugs,” and that its approach has lowered costs at the counter. Evernorth, the parent company of Express Scripts, called the allegations “baseless” and said it is committed to reimbursing pharmacies fairly.

Whether the companies’ cost-savings defense holds up will now be tested in court — but the lawsuit spotlights an industry that has faced growing bipartisan scrutiny for opaque pricing practices that squeeze out competition rather than fostering it.

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