Two Philadelphia pharmacies have filed a federal lawsuit against AmeriHealth Caritas and its pharmacy benefits manager subsidiary, PerformRx, alleging the companies illegally concealed transmission fees charged to pharmacies. The complaint, originally filed in April in a Philadelphia court, now proceeds in federal court. It adds to a growing wave of legal and regulatory scrutiny facing pharmacy benefits managers over fee transparency and pharmacy reimbursement practices.
The Core Allegations Against PerformRx and AmeriHealth Caritas
Who Filed the Lawsuit
Friendly Pharmacy and Samuel J. Robinson Pharmacy — both Philadelphia-based independent pharmacies — are the plaintiffs in the proposed class action. Both pharmacies have since closed. Friendly Pharmacy shuttered in 2024. Samuel J. Robinson Pharmacy announced its closure on social media last fall. Nevertheless, the lawsuit moves forward, with implications that could extend to a broader class of pharmacies that contracted with PerformRx.
What the Pharmacies Allege
The core allegation centers on how PerformRx handled transmission fees. The complaint states that PerformRx charged pharmacies these fees after the fact — not at the point of sale during real-time claim adjudication as industry practice and state law require. Furthermore, the pharmacies allege that AmeriHealth Caritas and PerformRx actively concealed and obscured the charging of those fees. The complaint notes that other PBMs properly disclosed transmission fees at the point of transaction, making PerformRx’s alleged conduct a deliberate departure from standard industry practice.
How the Hidden Fees Allegedly Worked
Fees Applied After Claims Were Processed
In a typical pharmacy transaction, fees are disclosed and applied during real-time claim adjudication — the moment a prescription is processed and a reimbursement amount is determined. The pharmacies allege that PerformRx instead applied transmission fees retroactively, after claims had already been adjudicated. This after-the-fact deduction reduced the amounts pharmacies actually received — sometimes dramatically. In some instances, according to the complaint, the retroactive fees reduced actual payments to pharmacies to nearly zero. This practice, the plaintiffs argue, violates Pennsylvania state law and caused serious financial harm to independent pharmacies operating on thin margins.
Financial Impact on the Plaintiff Pharmacies
Independent pharmacies typically operate with limited financial cushion. Unexpected post-adjudication fee deductions can therefore threaten their viability directly. The complaint’s assertion that payments were reduced to nearly zero in some instances illustrates the severity of the alleged harm. For small pharmacies like Friendly Pharmacy and Samuel J. Robinson Pharmacy, serving community and Medicaid populations, such reimbursement shortfalls can accelerate closure decisions. Additionally, the pharmacies argue the concealment of fees prevented them from making informed business decisions about whether to continue accepting PerformRx claims at all.
What the Pharmacies Are Seeking in Court
The plaintiffs seek several forms of relief. First, they request injunctive relief to stop the alleged unlawful fee practices. Second, they seek a court declaration of liability against PerformRx and AmeriHealth Caritas. Third, they ask for full reimbursement of the fees improperly withheld, plus applicable penalties. Fourth and most significantly, they seek treble damages — meaning three times the amount of actual damages suffered. Treble damages are available under certain consumer protection and unfair trade practice statutes and signal the seriousness with which the pharmacies view the alleged misconduct.
A Prior Pennsylvania Audit Adds Context
A 2024 Pennsylvania state audit of PerformRx adds important background to the lawsuit. That audit found that PerformRx had been transparent with pharmacies regarding transmission fees throughout 2022. However, the same audit found the company was not transparent with managed care organizations or the state’s Department of Human Services about those same fees. This distinction is significant. It suggests that while PerformRx may have disclosed fees to pharmacies at some level, the broader financial picture communicated to state oversight bodies and managed care partners was incomplete. Consequently, the audit reveals a pattern of selective disclosure that the current lawsuit now challenges from the pharmacy perspective.
PerformRx’s Pending Shutdown and Move to Optum Rx
The lawsuit arrives as AmeriHealth Caritas prepares to wind down PerformRx entirely. Earlier in 2026, AmeriHealth Caritas confirmed it is moving away from PerformRx following a multiyear review, transitioning its pharmacy benefit management functions to UnitedHealth Group’s Optum Rx. PerformRx will conclude its PBM operations in their current form on December 31, 2026. AmeriHealth Caritas noted it expects limited job impact, with many functions remaining in-house. The pending shutdown adds complexity to the litigation — raising questions about continuity, liability and the practical enforceability of any court-ordered remedies against an entity that will cease operations by year-end.
Broader Implications for PBM Transparency
The lawsuit against PerformRx reflects broader national pressure on pharmacy benefits managers to operate with greater transparency. Independent pharmacies across the country have raised similar concerns about PBM fee practices, spread pricing and retroactive payment adjustments. Moreover, state and federal regulators have intensified scrutiny of PBM business practices in recent years. For AmeriHealth Caritas — a Medicaid managed care organization jointly owned by Independence Blue Cross and Blue Cross Blue Shield of Michigan, serving members across 13 states and Washington, D.C. — the lawsuit carries reputational as well as financial stakes. AmeriHealth Caritas declined to comment on the pending litigation.
