Overview

As you may be aware, in 2021, AIDS Healthcare Foundation (AHF) filed a lawsuit against Prime Therapeutics (Prime), alleging that Prime's relationship with Express Scripts (ESI) was anticompetitive. The case was compelled to arbitration, and in January 2025, the arbitrator issued a ruling in favor of AHF, awarding damages under a theory that the arrangement violated the law. Note: This ruling is limited to the Prime/AHF contract; no other pharmacy contracts are impacted by this decision.  

Prime's response
Prime is a pharmacy benefit manager (PBM) owned by not-for-profit Blue Cross and Blue Shield Plans with a mission to make medications more affordable for our clients and the members we serve. We entered our arrangement with Express Scripts (ESI) to advance these goals and in compliance with all applicable laws.   

In the arbitration brought by AHF, Prime demonstrated how actual members saved on prescription drugs as a result of the agreement. With this ruling, AHF is seeking to rewind the clock to cause patients living with HIV/AIDS to pay more — not less — at their pharmacy and thereby enrich AHF’s bottom line. We strongly disagree with the arbitrator’s ruling in the case and the adverse impact it will have on individuals relying upon AHF for lifesaving medicine. 

How Prime works with ESI
Prime utilizes ESI to enhance our manufacturer and pharmacy network contracts and corresponding rates while maintaining our own claims processing and core functions, such as network management, formulary management, adherence and utilization management. This agreement makes us more competitive on prices, thus making medication more affordable for our clients and their members. Partnering in the health care space is a common industry practice and this agreement represents a continued emphasis on being the pharmacy solutions partner of choice by delivering value to those we serve. 

Next steps and questions
Prime is actively reviewing the ruling at this time to determine the best course of action and will promptly provide follow-up communications as necessary.  

For questions, please contact your account team representative or email ClientCommunications@PrimeTherapeutics.com.