Express Scripts Reaches Deal With FTC Over Insulin Pricing Practices

The move comes as the Trump administration continues its push to curb the price of medicines, an effort that has already produced price-cutting agreements with several pharmaceutical companies. According Reuters, the Express Scripts settlement supports that broader policy direction and also narrows a major federal case that was originally launched under the Biden administration against three of the largest pharmacy benefit managers in the country: Express Scripts, UnitedHealth Group’s Optum unit, and CVS Health’s CVS Caremark. While the claims involving Express Scripts will be settled, the lawsuits against Optum and CVS Caremark will continue.

Pharmacy benefit managers, or PBMs, play a powerful role in determining which drugs insurers cover and how much patients pay. For more than a decade they have been under pressure from lawmakers and regulators who argue that opaque pricing systems and rebate structures inflate drug costs. Per Reuters, even though the industry has already begun making changes, the new deal gives the FTC direct authority to enforce additional rules at Express Scripts.

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Under the agreement, which will run for 10 years, Express Scripts will face limits on business practices that critics say drive up prices, such as keeping rebate payments from drug manufacturers that are tied to a drug’s list price. According Reuters, the FTC believes these changes could save patients as much as $7 billion over the next decade. The settlement also puts Express Scripts under a three-year compliance monitorship, making the commitments legally binding.

The FTC has argued that the biggest PBMs often push insurers and patients toward more expensive medicines instead of cheaper alternatives to boost their own profits. In 2024, the agency sued Express Scripts, Optum and CVS Caremark, accusing them of unfairly blocking lower-priced insulin products from insurance coverage lists, per Reuters.

As part of its settlement, Express Scripts will be required to work more closely with local pharmacies and to provide employers with annual disclosures about drug costs. According Reuters, the company also agreed to relocate its rebate-collecting subsidiary, Ascent Health Services, from Switzerland to the United States.

The deal has implications for Cigna’s broader insurance business as well, since most of the company’s coverage involves employer-sponsored health plans. The settlement requires Cigna to count any direct purchases made by consumers through the White House’s proposed TrumpRX drug platform toward copayments and deductibles in its standard employer plans, per Reuters.

In recent years, the three major players in the PBM industry—CVS, UnitedHealth and Cigna—have introduced new pricing models that aim to make drug discounts, fees and underlying costs more transparent. According Reuters, the companies increasingly say they earn money through administrative fees rather than through hidden payments from drugmakers, a shift that regulators hope will lead to fairer and lower drug prices for patients.

Source: Reuters