Agreement requires major transparency and pricing reforms
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The Federal Trade Commission has reached a landmark settlement with Express Scripts, one of the nations largest pharmacy benefit managers, requiring sweeping changes aimed at lowering insulin costs and increasing transparency.
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The FTC estimates the agreement could reduce patients out-of-pocket drug costs by as much as $7 billion over the next decade while generating millions of dollars annually in new revenue for community pharmacies.
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The settlement resolves allegations that Express Scripts used anticompetitive rebating practices that inflated insulin list prices and shifted costs onto vulnerable patients.
The Federal Trade Commission has announced a major settlement with Express Scripts, Inc.and its affiliated entities that officials say could fundamentally reshape how prescription drugs especially insulin are priced and paid for in the United States.
The agreement settles an FTC lawsuit accusing Express Scripts of artificially inflating insulin list prices through rebating practices that favored higher-priced drugs and limited access to lower-cost alternatives. According to the complaint, those practices ultimately pushed higher out-of-pocket costs onto patients whose copays and coinsurance are tied to list prices rather than the actual net cost of medications.
Win for consumers
FTC Chairman Andrew Ferguson framed the settlement as a win for consumers, community pharmacies, and the administrations broader health care agenda.
This agreement will end business practices that have kept drug prices high, provide meaningful financial relief to patients who depend on life-sustaining prescription drugs, and give community pharmacies relief from being squeezed, Ferguson said.
The enforcement action against Express Scripts is part of a broader FTC case also targeting Caremark Rx and OptumRx.
The agency alleges the pharmacy benefit managers (PBMs) created a system in which drug manufacturers competed for preferred placement on formularies based on the size of rebates off inflated list prices, rather than on lower net prices. The FTC contends that PBMs kept a portion of those rebates, while patients bore the burden of higher list prices.
What it means
Under the proposed consent order, Express Scripts agreed to a series of changes designed to dismantle that system. Among other provisions, the company will stop favoring higher wholesale acquisition cost versions of drugs over identical lower-cost versions, offer plan sponsors options that base patient out-of-pocket costs on net prices, and delink manufacturer compensation from drug list prices.
The agreement also expands access to insulin affordability programs, requires greater transparency for plan sponsors through detailed drug-level reporting, and mandates disclosure of payments to brokers. Express Scripts will also transition its standard payment model for community pharmacies to one based on actual drug acquisition costs plus dispensing fees and compensation for non-dispensing services.
In a move the FTC highlighted as significant, Express Scripts also agreed to reshore its group purchasing organization, Ascent, from Switzerland to the United States. The agency said that change will bring more than $750 billion in purchasing activity back to the U.S. over the life of the order.
The Commission voted 1-0 to accept the proposed consent agreement for public comment, with Commissioner Meador recused. The public will have 30 days to submit comments before the FTC decides whether to finalize the settlement. Instructions for submitting comments are available on the docket, and all comments will be posted on Regulations.gov once processed.
Posted: 2026-02-05 16:31:28

















