WASHINGTON, D.C. — Yesterday, the Federal Trade Commission (FTC) announced a settlement with Cigna’s Express Scripts, resolving claims that the pharmacy benefit manager engaged in practices that artificially inflated insulin prices and harmed patients.

In response to the settlement, Merith Basey, CEO of Patients For Affordable Drugs, released the following statement: 

“Patients have been price-gouged for decades by shady PBMs whose business models have been intentionally structured to push patients toward higher-priced drugs. This settlement includes welcome reforms that aim to prevent Express Scripts from favoring higher-priced drugs, delink PBM compensation from list prices, allow patient cost-sharing to be based on a drug’s net price, and ensure fairer reimbursement to community pharmacies — long-overdue steps that move the system in the right direction. Ultimately, patients will judge progress by what they pay at the pharmacy counter. While PBM reform remains a top priority, Big Pharma should not be let off the hook. We will continue pressing for systemic reforms that hold drug manufacturers and PBMs accountable and deliver lower drug prices for patients.”

The public now has 30 days to submit comments on the proposed settlement, followed by a final FTC approval vote. The FTC’s cases against the other two dominant pharmacy benefit managers — CVS Caremark and OptumRx — remain ongoing. In September 2024, the FTC sued the nation’s three largest PBMs following a bipartisan report exposing secret agreements with drug manufacturers that incentivized higher list prices and restricted access to cheaper generics and biosimilars. Together, CVS Caremark, Express Scripts, and OptumRx control roughly 80% of prescriptions filled in the U.S. A subsequent FTC report found PBMs generated $7.4 billion by inflating the prices of 51 lifesaving drugs between 2017 and 2022, driving up patient costs across conditions including cancer, HIV, and heart disease. 

This settlement follows bipartisan action by Congress earlier this week, when lawmakers passed a government funding package that included new restrictions on PBM business practices, including changes to how PBMs are compensated in Medicare. Together, legislative and enforcement efforts signal growing momentum to rein in middleman practices that have contributed to unaffordable drug costs, while underscoring the need for continued oversight to ensure reforms deliver real savings for patients.

PBMs, however, are not the only bad actors in this system. Insulin manufacturers, led by the Big Three: Eli Lilly, Novo Nordisk, and Sanofi, have repeatedly raised list prices in lock-step, knowing those increases would be rewarded through rebate-driven arrangements. Any serious effort to lower drug costs must address both the practices of PBMs that profited from inflated prices and the manufacturers that set those prices.

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Patients For Affordable Drugs Now is the only national, patient advocacy organization focused exclusively on policies to lower drug prices. We empower and mobilize patients and allies, hold accountable those in power, and fight to shape and achieve system-changing policies that make prescription drugs affordable for all people in the United States. P4ADNow is bipartisan and does not accept funding from organizations that profit from the development or distribution of prescription drugs. To learn more, visit: PatientsForAffordableDrugsNOW.org