Pharmacy Benefit Managers (PBMS)
Three Pharmacy Benefit Managers (PBMs)—CVS Caremark, Express Scripts, and Optum Rx—now process almost 80 percent of all U.S. prescriptions. With that leverage, a growing body of research suggests that they can decide which drugs count as “specialty,” reimburse their own affiliated pharmacies at premium rates, and pay independent pharmacies pennies on the dollar, all while patients still see higher prices at the counter. These practices inflate drug costs, impose retroactive clawback fees, and squeeze community pharmacies to the brink of closure.
Loevy + Loevy is challenging this abuse of market power on behalf of pharmacies and the consumers they serve. If your independent or community pharmacy’s reimbursements plunged, or if you paid more at the register because a PBM steered you away from affordable options, our class action may help you recoup losses and restore fairness to the supply chain.
We work on contingency, so you pay nothing unless we win. Please take two minutes to complete the secure questionnaire below. Our team will review your answers at no charge and contact you if you qualify.
At a Glance
Who is affected?
Independent and community pharmacies nationwide that have pharmacy network contracts with big PBMs like CVS Caremark, Express Scripts, Optum Rx, or Prime Therapeutics, and potentially anyone who pays high out of pocket costs for big name drugs like Humira .
The Big Three PBMs control ≈ 80% of U.S. prescriptions and, according to recent congressional and FTC findings, use that dominance to:
(i) re-label profitable drugs as “specialty;” (ii) reimburse their own pharmacies at premium rates while low-balling unaffiliated pharmacies; (iii) impose retroactive fees on pharmacies; (iv) steer patients to PBM-owned outlets; and (v) negotiate sweetheart rebate deals with major manufacturers that can increase out-of-pocket costs for patients and policyholders. The result is higher costs, fewer community pharmacies, and less control for patients over their own healthcare.
Current stage
National investigation underway. We are gathering documents and talking with pharmacists, patients, and pharmaceutical supply chain experts to prepare a multi-state class action.
Your rights
Pharmacies may recover underpaid reimbursements and treble damages under federal and state antitrust laws; affected consumers may seek reimbursement of inflated out-of-pocket costs and an injunction forcing transparent, competitive pricing.
Cost
No upfront fees. Loevy + Loevy advances all litigation costs and is paid only if we win or settle favorably.
PBMs wrote the rules, then moved the goalposts
By redefining ordinary medicines as “specialty,” the Big Three reimburse their own mail-order and big-box pharmacies at top-shelf rates while paying independents less than acquisition cost. Add opaque spread pricing and retroactive clawback fees , and local pharmacies are left filling prescriptions at a loss, forcing staff cuts, shortened hours, and, too often, permanent closure. Meanwhile, patients pay more at the counter and travel farther for care.
If your pharmacy’s margins collapsed or you’ve seen your out-of-pocket costs spike after being nudged to a PBM-owned pharmacy, share your story through the confidential form below. Your information stays private, the review is free, and you owe nothing unless we secure compensation. Together, we can restore fair reimbursements, protect patient choice, and hold PBMs accountable.
Submission Form
FAQs
Will the PBM cancel my contract if I join?
Federal antitrust and whistle-blower laws forbid retaliation. If PBMs try anyways, we can ask the court for an immediate injunction.
Do I have to drop CVS, Express Scripts, or Optum prescriptions to take part?
No. Keep filling prescriptions and serving patients as usual. The lawsuit targets unfair payment terms, not your day-to-day pharmacy operations.
How much could we recover?
Independent pharmacies have suffered a lot of harm at the hands of PBMs, ranging from unfair reimbursement to customers getting steered to PBM-affiliated pharmacies. Your damages depend on how much your business has suffered as a result, which are then tripled under antitrust rules. Consumers may claim refunds on inflated out-of-pocket expenses. Exact amounts depend on the evidence and court rulings.
What records should I save?
Hold on to reimbursement statements, remittance advice, DIR fee notices, PBM contracts or amendments, and any register receipts showing high copays. Digital copies (PDF or spreadsheet) are fine.
Will this cost me anything?
There is no upfront fee. Loevy + Loevy advances all litigation expenses, and is paid only if we win a settlement or verdict.
How much time will this take me?
These cases are large and complicated. Although we handle the filings, motions, and any trial, participating in the case will require your attention at times. For independent and community pharmacies that agree to sign up as named plaintiffs, expect to spend at least a couple hours talking with us so that we can learn about your business and authentically tell your story. You will need gather documents related to your business and your interactions or contracts with PBMs, and you will probably be asked to provide deposition testimony. Although some of these tasks may take several hours to complete, they are spread out over the life of the case. Nothing should create unmanageable burdens on your time all at once.
For individual patients, most class members spend under an hour gathering documents and signing a few forms. Only lead plaintiffs may need a short deposition.
If this sounds daunting, don’t worry. We are experts at helping our clients navigate this process, and we will be with you every step of the way.
Why Join a Class Action?
Joining a class action means shared costs, greater leverage, and a real chance to hold wrongdoers accountable—all without taking on the fight alone. And you pay nothing unless we win.i
