The Federal Trade Commission (FTC) and pharmacy benefit manager Express Scripts, Inc. have reached what the FTC called a landmark settlement of a lawsuit brought by the agency, alleging that the company artificially inflated insulin drug prices.
According to a Feb. 4 FTC statement, Express Scripts will now be required to adopt “fundamental changes to its business practices that increase transparency.”
This is expected to lower patients’ out-of-pocket costs for drugs such as insulin by up to $7 billion over the next 10 years.
The FTC also said that the settlement should bring millions of dollars in new revenue to community pharmacies annually.
Owned by The Cigna Group, Express Scripts was also accused of using anticompetitive and unfair rebating practices and blocking patients’ access to lower list-price pharmaceuticals, often resulting in patients paying the lion’s share of insulin charges.
“The FTC’s settlement with Express Scripts is a clear testament to the Trump-Vance FTC’s focus on lowering healthcare costs for American patients,” FTC Chairman Andrew Ferguson said in the statement.
“The FTC’s settlement with ESI will end its business practices that have kept drug prices high, ultimately providing meaningful financial relief to American patients who depend on ESI to access life-sustaining prescription drugs as well as community pharmacies who will see new revenues each year and relief from being squeezed.”
Ferguson added that the settlement will ensure regulatory compliance with price transparency laws and require Express Scripts to disclose any kickbacks to brokers.
The FTC also took action against CVS Caremark RX and OptumRX, two other pharmacy benefit managers, claiming that they, too, created a system to artificially drive up the list prices of drugs by preferencing rebates.
The FTC alleged that this system has forced insulin manufacturers to compete based on the size of rebates off the list price, rather than the net price. Typically, patients’ out-of-pocket expenses are tied to the list price of the drugs.
The lawsuit against all three firms was filed in September 2024, but to date, only Express Scripts has agreed to settle.
Additional stipulations of the FTC consent order for Express Scripts include ensuring that patients’ out-of-pocket expenses will be based on the drug’s net cost, rather than list price, as well as providing covered access to TrumpRx—a federal initiative and website announced in September 2025 to help consumers find lower prescription drug prices—as part of its standard offering.
Express Scripts will also be required to provide a standard offering to all plan sponsors that allows the sponsor to transition off rebate guarantees and spread pricing, and to delink drug manufacturers’ compensation to Express Scripts from list prices as part of its standard offering.
Spread pricing occurs when a pharmacy benefit manager charges a health plan or employer more for a medication than it pays the pharmacy for it, and then pockets the difference, or spread.
The FTC settlement is also calling for Express Scripts to reshore its group purchasing organization, Ascent, from Switzerland to the United States. This move is expected to bring more than $750 billion in purchasing activity back to America.
The public will have 30 days to submit comments on the proposed consent agreement package.
The Epoch Times reached out to Cigna for comment but did not hear back by time of publication.
