Express Scripts agreed Wednesday to what the Federal Trade Commission described as a “landmark settlement,” committing to sweeping revisions in how it structures drug formularies — and sidestepping a high-profile case that accused the nation’s three largest pharmacy benefit managers of driving up insulin prices through rebate tactics.
The agreement marks a dramatic pivot in a fight that has cast pharmacy benefit managers, or PBMs, as middlemen under the microscope. While Express Scripts exits the FTC’s in-house case, proceedings remain active against rival giants Caremark Rx and OptumRx.
A Decade of Promised Savings
The FTC said the Express Scripts FTC Changes could translate into “up to $7 billion” in reduced out-of-pocket drug costs for patients over the next 10 years.
At the heart of the dispute was a pricing structure critics likened to a hall of mirrors — list prices rising ever higher while rebates flowed behind the scenes. Regulators argued that those rebate arrangements inflated insulin costs, leaving patients to shoulder bills tied to artificially elevated sticker prices.
