Brad Gallagher, co-leader of the Health Care Controversies and Pharmacy Teams, was featured in the September 28, 2026, edition of The Capitol Forum’s “Antitrust Agenda,” discussing how state attorneys general (AGs) are increasingly turning to antitrust lawsuits to rein in pharmacy benefit managers (PBMs) as part of a growing bipartisan effort to lower drug prices. The article highlights Florida AG James Uthmeier’s second PBM antitrust lawsuit in less than a month, a case over inflated insulin costs that names diabetes medication manufacturers, PBMs, and rebate aggregators as defendants. His earlier suit accuses PBMs Prime Therapeutics and Express Scripts of price-fixing, and Louisiana filed a similar price-fixing lawsuit in August.
Although all 50 states have passed laws regulating PBMs in some way, courts have blocked some of the strongest measures, such as Arkansas’s and Tennessee’s bans on PBMs owning pharmacies and Illinois’s new PBM reporting requirements, while legal challenges play out. Brad explained that even where laws do take effect, enforcement brings unforeseen challenges, including state agencies that cannot or will not act, PBM legal workarounds, and federal preemption rulings. “You’ll have these laws or regulations, and then you’ll have no mechanism to enforce them through the state,” he said. “The state agency doesn’t think that they have enforcement capability in some instances, or they’ll believe that it’s a private dispute.” Brad added that private parties may lack the resources to sue or, where a PBM law includes no private right of action, the right to do so at all.
State antitrust lawsuits may offer another path. Florida and Louisiana join California, Iowa, Michigan, Missouri, Oregon, and Vermont in suing PBMs, and Brad noted that AG-led cases may succeed where similar private suits have failed. “The facts are different. Who’s bringing the cases now is different. There’s definitely more information out there with the FTC’s investigations. Various states have done a lot of investigations themselves,” he said. With Florida’s June announcement of an investigation into CVS Caremark, more state actions may be on the way.
As state PBM statutes face enforcement gaps, court challenges, and preemption hurdles, state AGs are using antitrust litigation, backed by a growing body of federal and state investigative findings, as an increasingly prominent tool to challenge PBM practices and drug pricing.
Read the full article in here.