The Federal Trade Commission reached a settlement with Cigna’s Express Scripts in a case over alleged inflation of insulin prices, according to a Feb. 4 agency news release.
With the move, the FTC expects to lower out-of-pocket costs for drugs like insulin by $7 billion over a decade, the news release said. The FTC did not share the specific methodology behind this projection.
Under the settlement, Express Scripts must keep drug manufacturer compensation delinked from list prices, promise insulin savings unless a plan sponsor opts out and avoid favoring drugs with high list prices over cheaper alternatives. Other stipulations include allowing plan sponsors to move away from rebate guarantees, keeping out-of-pocket expenses based on the drug’s net cost and paying retail community pharmacies based on the real costs of drugs.
Transparency is another cornerstone of the agreement, requiring mandatory reporting and payment disclosures to brokers. This builds off proposed regulation from the Labor Department that would require PBMs to disclose compensation with self-insured group plans.
Some of the settlement speaks directly to President Donald Trump’s agenda for PBMs, such as by requiring Express Scripts to offer access to TrumpRx and reshore its group purchasing organization from Switzerland.
“As enforced by the settlement, our new, transparent pharmacy benefits model ensures our members get their medicines at the lowest price — whether it’s the Express Scripts negotiated cost, their copay or a cash discount price. We’ll also provide access to TrumpRx as part of our standard offering, upon relevant legal and regulatory changes, and purchases through TrumpRx will count toward our members’ deductibles and out-of-pocket maximums,” Express Scripts said in a Feb. 4 statement. “This is a meaningful step toward affordability for millions of families, and toward advancing the goal we share with the administration of full transparency into prescription drug costs. Today’s settlement charts a clear path forward for pharmacy benefits in America.”
The lawsuit began in September 2024, targeting CVS Caremark, Optum Rx and Express Scripts. In response, the pharmacy benefit managers filed their own lawsuit. The FTC paused its proceedings in April 2025 due to a lack of participating commissioners before lifting the motion to stay, which PBMs met with resistance. Recently, the FTC withdrew the matter from adjudication for Express Scripts, as well as paused the case to allow settlement discussions with other respondents.
Prior to the lawsuit, PBMs were already under federal scrutiny. In 2022, the FTC launched a probe into the six largest PBMs. The commission’s initial report in July 2024 showed how PBMs could hike drug costs.
This year, the momentum has continued. Key reforms, sponsored by Rep. Earl “Buddy” Carter (R-Ga.), were recently passed as part of the Consolidated Appropriations Act, 2026, which ended the brief government shutdown. Several pharmacy groups have supported the reforms.
