Antitrust enforcement action where the FTC settled with Express Scripts, a major pharmacy benefit manager, for using anticompetitive rebating practices that artificially inflated insulin prices. The settlement requires ESI to change its business practices to increase transparency and lower patient out-of-pocket costs, potentially saving $7 billion over 10 years.
Express Scripts must stop preferring high-cost drug versions, base member out-of-pocket costs on net price, provide standard offerings to plan sponsors, increase transparency with drug-level reporting, transition pharmacy payments to a cost-based model, reshore its group purchasing organization, and promote these standard offerings.
In-house legal teams should review all Pharmacy Benefit Manager (PBM) contracts, including agreements with health plans/insurers, pharmaceutical manufacturers, and network pharmacies. Specific clauses to scrutinize are those governing rebate structures and calculations, formulary placement and tiering logic, transparency reporting requirements, and provisions that restrict patient access to lower-cost alternatives (e.g., anti-tying or exclusionary clauses). Changes may be needed to remove anti-competitive terms, mandate full rebate pass-through to plans/patients, require clear disclosure of pricing and spread calculations, and ensure formulary decisions are based on clinical efficacy and net cost rather than rebate size. Contracts should also be amended to grant robust audit rights and prohibit 'gag clauses' that prevent pharmacies from informing patients about lower-cost cash pricing options.
Entity
Express Scripts, Inc.
Also known as: Express Scripts
Industry
HealthcareOfficial Press Release
https://www.ftc.gov/news-events/news/press-releases/2026/02/ftc-secures-landmark-settlement-express-scripts-lower-drug-costs-american-patients
d09437caremarkproporder esiresps
https://www.ftc.gov/system/files/ftc_gov/pdf/d09437caremarkproporder-esiresps.pdf
express scripts inc et al analysis of agreement containing c
https://www.federalregister.gov/documents/2026/02/12/2026-02844/express-scripts-inc-et-al-analysis-of-agreement-containing-consent-order-to-aid-public-comment
ftc sues prescription drug middlemen artificially inflating
https://www.ftc.gov/news-events/news/press-releases/2024/09/ftc-sues-prescription-drug-middlemen-artificially-inflating-insulin-drug-prices
Federal Trade Commission Enforcement Page
https://www.ftc.gov/enforcement
"Express Scripts, Inc., and its affiliated entities (collectively “ESI”)"
"The FTC’s enforcement action against ESI, as well as Caremark Rx and OptumRx, alleges that the PBMs created a system that artificially drove up the list prices of drugs by preferencing rebates."
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$1.9M
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