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FTC Settlement with Express Scripts to Lower Insulin Prices by $7B

Express Scripts, Inc.February 4, 2026Federal Trade Commission

Summary

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.

Remedy

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.

InjunctionConsent DecreeCompliance ProgramReporting Requirements

Contract Impact

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.

Contract Search Terms

rebate transparencyformulary managementpatient cost-sharinganti-tying provisionsaudit rightsMost Favored Nation (MFN) clausesspread pricingrebate pass-through requirementsnetwork adequacygag clauses

Violation Types

Entity Details

Entity

Express Scripts, Inc.

Also known as: Express Scripts

Industry

Healthcare

Official Sources

Source Evidence

Entity Name
"Express Scripts, Inc., and its affiliated entities (collectively “ESI”)"
Summary
"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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