In a landmark settlement, Cigna’s pharmacy benefit manager Express Scripts agreed to resolve the Federal Trade Commission’s allegations that its insulin pricing practices violated antitrust and consumer protection laws.
The case, originally brought by the previous administration, targeted Express Scripts along with UnitedHealth’s Optum unit and CVS Health’s CVS Caremark. While the lawsuit against Optum and Caremark remains active, the deal with Express Scripts signals a shift toward broader reforms in the industry.
The 10‑year agreement bars Express Scripts from several practices critics say inflate prices—such as pocketing rebates tied to list prices—and requires the company to work closely with local pharmacies, disclose drug costs to employers each year, and relocate its Swiss rebate aggregator to the United States.
FTC officials estimate that the deal could save patients up to $7 billion over the next decade, and the agreement places Express Scripts under a three‑year monitoring period to ensure compliance.
Pharmacy benefit managers have faced growing scrutiny for steering patients toward higher‑priced drugs to maximize profits. In 2024, the FTC accused the trio of unfairly excluding lower‑cost insulin options from insurance formularies, a practice that sparked the original lawsuit.
As part of the settlement, Cigna’s broader insurance business will now count direct‑to‑consumer drug purchases through a federal program against standard plan copays and deductibles, bringing greater transparency to drug costs.
With this settlement, the largest PBMs are taking concrete steps to make insulin more affordable, reflecting a broader push across the industry to shift revenue from hidden rebates toward clearer administrative fees.
