Cigna Corp’s pharmacy benefit management unit, Express Scripts, has agreed to a settlement with the U.S. Federal Trade Commission resolving claims that its insulin pricing practices violated antitrust and consumer protection laws. According to the FTC, the agreement introduces enforceable changes designed to lower insulin-related costs for patients, insurers, and small pharmacies.
Pharmacy benefit managers play a central role in the U.S. healthcare system by determining how prescription drugs are covered under insurance plans and how much patients pay out of pocket. Express Scripts’ settlement addresses concerns about how insulin prices are structured and reimbursed, particularly practices critics say have contributed to higher patient costs. The agreement allows the FTC to narrow a broader lawsuit involving Express Scripts, UnitedHealth Group’s Optum unit, and CVS Health’s CVS Caremark. The case against Optum and Caremark remains ongoing.
Express Scripts said the settlement supports efforts to reduce drug costs and aligns with changes the company has already begun to implement. In a statement, the company said, “Our priority is simple: lowering drug costs for Americans. This settlement enables us to keep moving forward, and we appreciate the Administration’s reinforcement of our commitment to pharmacy benefits that put Americans first,” according to Express Scripts.
The settlement places a 10-year restriction on Express Scripts’ ability to engage in pricing practices that have been criticized for inflating insulin costs. These include retaining rebate payments from drug manufacturers that are calculated based on a drug’s list price. The FTC estimates that the changes could save patients up to $7 billion over the next decade. Although Express Scripts announced last year that it would move away from rebate-based pricing, the settlement makes this change mandatory. An independent monitor will oversee compliance with the agreement for three years.
Regulators have accused major pharmacy benefit managers of steering insurers and patients toward higher-priced medications while excluding lower-cost alternatives. In 2024, the FTC sued Express Scripts, Optum, and CVS Caremark, alleging that they unfairly excluded lower-cost insulin products from insurance formularies. The Express Scripts settlement directly addresses those concerns by limiting practices tied to list-price incentives.
The agreement also includes measures affecting pharmacy operations and employer transparency. Express Scripts is required to work more closely with local pharmacies and provide annual disclosures to employers detailing drug costs. These provisions are intended to improve visibility into how insulin and other medications are priced and reimbursed within insurance plans.
As part of the settlement, Express Scripts agreed to relocate Ascent Health Services, its Switzerland-based rebate aggregation unit, to the United States. The deal also affects Cigna’s insurance offerings for employer-sponsored plans. Cigna must count any direct-to-consumer drug purchases made through the White House’s planned TrumpRX platform toward copays and deductibles under its standard employer plan.
A spokesperson for UnitedHealth did not immediately respond to a request for comment. CVS spokesperson David Whitrap said the company is engaged in negotiations with FTC staff to reach a resolution that would avoid prolonged litigation while preserving its ability to negotiate lower drug costs for clients and plan members.
What the FTC Settlement Requires
According to the FTC, the settlement with Express Scripts resolves allegations that the company engaged in anticompetitive rebate and pricing practices that artificially inflated insulin list prices and harmed patients. Under the terms the FTC secured, Express Scripts must implement a series of structural reforms — including increasing price transparency, adjusting drug formularies, and revising reimbursement models — to help lower costs for patients and strengthen competition.
FTC’s Goals Behind the Enforcement Action
The FTC says the settlement is part of broader efforts to tackle unfair pharmacy benefit manager (PBM) practices and lower prescription drug costs for millions of Americans. By requiring Express Scripts to delink compensation from list prices and ensure members pay based on the lowest available price, the FTC expects patients’ out-of-pocket expenses — particularly for insulin — to drop significantly over the next decade.
