The Federal Trade Commission has reached a settlement with Express Scripts and its affiliated entities to resolve claims that the pharmacy benefit manager used unfair rebate practices that kept insulin list prices high. The agency said these practices raised out-of-pocket costs for patients who rely on insulin and limited access to lower-priced options. Under the agreement, Express Scripts must change how it structures formularies, rebates, and reporting to plan sponsors.
FTC Chairman Andrew N. Ferguson said, “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,” adding that it will bring “meaningful financial relief to American patients who depend on ESI to access life-sustaining prescription drugs.”
The consent order also introduces new transparency and pricing standards across the drug supply chain. Express Scripts must ensure that patient cost sharing reflects the net price of a drug rather than an inflated list price and must allow plan sponsors to move away from rebate-based and spread-pricing models. The company will also shift payments to community pharmacies to a model based on actual drug acquisition costs plus dispensing fees and service payments. In addition, it will move its Ascent purchasing unit back to the U.S., bringing more than $750 billion in purchasing activity over the life of the order.
