Attorney General Neronha protects local pharmacies from alleged illegal practices by PBMs

Attorney General Neronha protects local pharmacies from alleged illegal practices by PBMs

Published on Wednesday, February 04, 2026

Attorney General Peter F. Neronha announced today that the Office has concluded its enforcement action against pharmacy benefit manager (PBM) Prime Therapeutics, LLC for allegedly violating a state law restricting certain pharmacy audits by conducting unannounced audits of three Rhode Island pharmacies.

"Where there's money to be made, there will inevitably be those willing to exploit an industry to maximize profit, and unfortunately, health care is not exempt," said Attorney General Neronha. "This is precisely why my Office filed a lawsuit against three of the largest PBMs last year. We allege that these groups often exploit the complex scheme of pricing and payment for prescription drugs, and take a cut of ever-increasing drug prices at every step of the way. Here, we allege that Prime Therapeutics violated the law when they caused undue administrative burden and disruption to three independent Rhode Island pharmacies by showing up unannounced and demanding to see their books. This kind of behavior can drive up pharmacy costs, limit care choices, and harm local businesses if left unchecked. So, we checked it."

The Rhode Island General Assembly enacted the Pharmacy Audit Act (R.I. Gen. Laws § 5-19.1-35) to protect pharmacies from unfair, anticompetitive audit activities by PBMs, insurance carriers, and other intermediaries. The law grants the Office of the Attorney General enforcement authority and establishes requirements with which PBMs must comply when conducting on-site audits, including but not limited to:

• limiting audits to one per pharmacy per year unless fraud is suspected
• providing 14-day advance notice for audits
• prohibiting auditors from receiving pay based on recouped money, and
• barring extrapolation in audit findings.

As alleged in a complaintfiled in Providence Superior Court, on October 27, 2025, Prime Therapeutics initiated unannounced on-site audits of three independently owned local pharmacies. Further, as alleged, Prime failed to provide pharmacies with advanced notice of the range of prescription numbers involved in the audit; audited for a period which exceeded two years; and refused to allow pharmacies an opportunity to reschedule with the auditor - all alleged violations of the law.

In an Assurance of Voluntary Compliance(AVC) filed in court, Prime Therapeutics agrees to terminate the aforementioned audits initiated on October 27, 2025 and agrees to conduct all future audits in compliance with the law. Prime Therapeutics also agrees to several additional provisions which the Office has determined will help ensure Prime's future compliance with the law.

As previously mentioned, the purpose of the Pharmacy Audit Act is to mitigate the administrative burden and disruption to patient care that Rhode Island pharmacies face when audited by carriers and their intermediaries, and to provide certain basic procedural protections so that pharmacies can adequately prepare for and respond to audits. Many PBMs own or selectively partner with certain pharmacies that directly compete with independent pharmacies, such as those the Pharmacy Audit Act aims to protect. Therefore, PBMs may have incentives to increase administrative costs burdens and potentially find ways to claw back payments from these independent and competitor pharmacies.

Today's announcement follows a 2025 lawsuitby the Office against the country's largest PBMs (CVS Caremark, Express Scripts, and Optum) and their affiliated Group Purchasing Organizations (Zinc, Ascent Health Services, Emisar Pharma Services) for their alleged role in unfairly and deceptively increasing the costs of prescription drugs, limiting care choices for Rhode Islanders, and harming local businesses.

To learn more about the Office's health care initiatives, please visit our dedicated website.

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