The Federal Trade Commission (FTC) has reached a settlement with Express Scripts, Cigna’s pharmacy benefit manager (PBM), in a case centered on alleged insulin price inflation. The agreement is expected to reduce out-of-pocket drug costs — including insulin — by an estimated $7 billion over the next decade.
Under the settlement, Express Scripts must delink manufacturer compensation from drug list prices, avoid favoring higher-priced drugs over lower-cost alternatives, and ensure patient cost-sharing is based on a drug’s net price rather than its inflated list price. The agreement also strengthens transparency requirements, including mandatory reporting and payment disclosures, aligning with broader federal efforts to increase oversight of PBM practices.
This case is part of a larger federal crackdown on PBMs, including ongoing scrutiny of major players like CVS Caremark and Optum Rx, as well as recent legislative reforms included in the Consolidated Appropriations Act of 2026. The settlement also intersects with elements of former President Donald Trump’s PBM policy agenda, including provisions related to TrumpRx.
With PBM regulation evolving rapidly at both the federal and legislative levels, stakeholders should monitor these developments closely.
Resource: FTC deal over insulin prices forces Express Scripts to overhaul policies