FTC settles with prescription drug middleman giant to lower pricing

The agreement orders Express Scripts to offer plan members the lowest available cost for medicine like insulin rather than artificially inflated prices.

by Joe Dodson, CourtHouseNews, February 4, 2026

WASHINGTON (CN) —The Federal Trade Commission announced what it called a landmark settlement agreement Wednesday, which it claims could lower the prices of drugs like insulin up to $7 billion in a decade.

The commission secured an agreement from Express Scripts, a pharmacy benefit manager, which — along with competitors CVS Health’s Caremark and United Health Group’s OptumRx — controls 80% of the country’s prescription drug market.

Pharmacy benefit managers are middlemen who manage prescription drug plan benefits for insurers through negotiating rebates and discounts with manufacturers and setting drug formularies. Drug formularies are tiered lists that determine which drugs are available, at what out-of-pocket costs and with what restrictions for insured consumers.

“The FTC’s settlement with ESI will end its business practices that have kept drug prices high, ultimately providing meaningful financial relief to American patients who depend on ESI to access life-sustaining prescription drugs as well as community pharmacies who will see new revenues each year and relief from being squeezed,” Commission Chairman Andrew Ferguson said.

“It also delivers significant wins for the broader Trump-Vance health care agenda, including reshoring major portions of ESI’s business, ensuring regulatory compliance with price transparency laws, requiring disclosures of kickbacks to brokers, and paving the way for Americans to participate fully in TrumpRx,” Ferguson said. Ferguson was the only commissioner to approve the deal after Commissioner Mark Meador recused himself.

The FTC first filed its administrative complaint under the Biden administration in 2024, claiming Express Scripts and its competitors manipulated market prices by threatening drug manufacturers with exclusion from coverage unless they raised rebates, impairing patients’ ability to access lower-priced products.

Express Scripts and its affiliated entities, based in St. Louis, are the country’s second-largest pharmacy benefit manager, accounting for 23% of total prescriptions.

Among other provisions, the company agreed to stop preferring high wholesale acquisition cost versions of a drug over identical low wholesale acquisition cost versions, provide an offering to its plan sponsors that ensures that members’ base out-of-pocket expenses on the drug’s net cost, rather than its artificially inflated list price and provide coverage to TrumpRx, should it ever launch.

The agreement also aims to increase transparency for plan sponsors by mandating drug-level reporting and disclosing payments to brokers representing plan sponsors. The agreement also reshores the company’s purchasing organization, Ascent from Switzerland, to the United States.

In a statement, Express Scripts embraced the agreement.

“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,” the company said. “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 agreement notably doesn’t include any deal with Caremark or OptumRx, which the commission also sued. The public has 30 days to comment on the proposed agreement.

The agreement comes after states from Virginia to Texas to Hawaii sued over skyrocketing insulin prices. Delaware sued Express Scripts and other pharmacy benefit managers, as well as insulin manufacturers, in January.

According to the Yale School of Medicine, insulin costs up to 10 times more in the United States than in other nations. The school claims that the same vial of insulin that cost $21 in the U.S. in 1996 now costs upward of $250, despite costing $2 to $4 to produce.