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."
The FTC rescinded its 2021 Policy Statement on Breaches by Health Apps and Other Connected Devices, which had purported to apply the Health Breach Notification Rule to health apps and connected devices that collect consumer health information. The rescission follows the Commission's 2024 update to the Health Breach Notification Rule, which already covers health apps and connected devices like fitness trackers, and implements an executive order directing agencies to eliminate obsolete guidance documents. No company was charged or penalized; this is a deregulatory action.
$12.0M
The FTC alleged that payment processor Humboldt Merchant Services knowingly processed payments for more than 1,000 shell merchant entities serving as fronts for fraudulent companies engaged in unauthorized billing scams, despite red flags including chargeback rates nearly 10 times higher than card-brand thresholds. Under the proposed stipulated order filed in the U.S. District Court for the Eastern District of Michigan, Humboldt will pay $12 million for consumer redress and is permanently banned from processing payments for merchants with a heightened risk of potential fraud.
$4.8M
The FTC charged Canada-based payment processor Nuvei Corporation and its subsidiaries with knowingly processing payments for fraudulent merchants, including more than $30 million in payments for the Reimage tech support scam from 2017 to 2023, as well as merchants making false earnings claims and impersonating government tax authorities. Under the stipulated order filed in the U.S. District Court for the District of Arizona, Nuvei will pay $4.85 million for consumer redress, is banned from serving tech support telemarketers, and must implement robust merchant screening and chargeback monitoring practices. Note: this is a payments-fraud facilitation action under the FTC Act and Telemarketing Sales Rule, not a data privacy violation.
The FTC announced a seven-day extension of the public comment period on its proposed enforcement policy statement regarding personalized pricing, pushing the deadline from Sept. 18, 2026 to Sept. 25, 2026. Personalized pricing refers to using personal data to set prices based on what the company believes an individual consumer is willing to spend. This is a procedural announcement about draft agency guidance, not an enforcement action against any company, and no entity was named, no violation found, and no penalty imposed.
Colorado Attorney General Phil Weiser joined the FTC and 22 state attorneys general in filing a lawsuit against Amazon for manipulating the auctions used to set advertising prices, replacing actual auction results with higher prices since 2019 and overcharging nearly 1.2 million U.S. advertising customers. The FTC estimates total improper surcharges from 2018 to 2026 exceed $20 billion, with costs ultimately passed to shoppers through higher prices. The states seek a permanent injunction and monetary relief; no penalty has been imposed yet as this is a newly filed complaint.
$930K
The FTC finalized orders requiring CMG Media Corporation (doing business as Cox Media Group), MindSift LLC, and 1010 Digital Works LLC to pay a total of $930,000 for falsely claiming they offered an AI-powered service that could target ads based on conversations captured from consumers' smart devices, and that consumers had opted into such targeting. The orders also prohibit the companies from making misrepresentations about their advertising services, voice data collection, and consumer consent.