Pharmacy Benefit Managers · Pharmacy Benefit Manager · Regulatory action
Express Scripts (Cigna)
Headline
Express Scripts was the first of the three big PBMs to settle, on February 4, 2026, on terms the FTC projects will cut patient out-of-pocket costs by up to $7 billion over ten years.
Express Scripts was the first of the three big PBMs to settle, on February 4, 2026, on terms the FTC projects will cut patient out-of-pocket costs by up to $7 billion over ten years. Read that number backwards and it is the finding: the FTC projects that changing a single company's practices will save patients up to $7 billion over a decade, and it took a federal antitrust action to change them. Express Scripts also agreed to offer plan sponsors a benefit design where out-of-pocket costs are based on the NET price of a drug rather than the list price - which means until now the default was the opposite, and patients were routinely paying a percentage of a number nobody in the transaction actually pays. Cross-ref the Cigna row in Life-Health-Dental; the PXDX claim-denial matter there is a separate issue and should not be blended with this one.
- Severity
- Evidence tierUnassigned
- Claims confirmed
- Last verified2026-08-04
Primary source. www.ftc.gov/terms/pharmacy-benefits-managers-pbm — Verified - primary source confirmed.
Terms
Arbitration
Not independently confirmed this pass — standard binding arbitration + class action waiver expected for individual member disputes, separate from the government-brought FTC action.
Data sharing
SAME FTC INSULIN-PRICING CASE as Caremark/OptumRx (see Caremark row) — Express Scripts was the FIRST of the three PBMs to formally SETTLE (Feb 4, 2026), in what the FTC itself called a 'LANDMARK SETTLEMENT.' Under the settlement, Express Scripts must fundamentally change its business practices: it will STOP favoring high wholesale-acquisition-cost versions of a drug over identical low-WAC versions on its standard formularies, must DISCLOSE broker kickbacks, and must include the direct-to-consumer 'TrumpRx' platform as part of its standard offerings. The FTC projects these changes will reduce patients' out-of-pocket drug costs (including for insulin) by UP TO $7 BILLION OVER 10 YEARS, while also bringing new annual revenue to community pharmacies that had been financially squeezed by the prior rebate structure.
Fees and billing
This is a DIRECT fee/pricing settlement — the $7 billion in projected savings over 10 years is one of the largest projected consumer-cost-reduction figures found anywhere in this entire tracker.
Contacts
Privacy contact. Not recorded.
Legal notice. Not verified this pass. If publicly traded: SEC Form 10-K cover page gives the official corporate address; the Secretary of State business-entity search in the state of incorporation gives the registered agent, which must accept service. If private: the state registered agent is usually the only reliable route.
Mailing address. Not recorded.
Evidence
| Claim | Kind | Support | Sources |
|---|---|---|---|
| 1. Express Scripts settled with the FTC on February 4, 2026. | fact | supported | none recorded |
| 2. Express Scripts was the first of the three big PBMs to settle. | fact | unsupported | none recorded |
| 3. The FTC projects the terms will cut patient out-of-pocket costs by up to $7 billion over ten years. | fact | supported | none recorded |
| 4. The $7 billion reflects Express Scripts' rebate practices. | fact | unsupported | 1 (0 confirmed) |
| 5. It took a federal antitrust action to change these practices. | fact | unsupported | 1 (1 confirmed) |
| 6. Read backwards, a single company's rebate practices were worth $7 billion in avoidable patient spending. | characterization | n/a | none recorded |
| 7. Express Scripts agreed to offer plan sponsors a benefit design basing out-of-pocket costs on net rather than list price. | fact | unsupported | none recorded |
| 8. Until now the default was the opposite, with patients paying a percentage of a price nobody pays. | characterization | n/a | none recorded |
| 9. Cross-ref the Cigna row; the PXDX claim-denial matter is separate and should not be blended. | characterization | n/a | none recorded |
1 of 9 claims have a confirmed source of their own.
Sources
| Source | Claim | Tier | Status | Quote |
|---|---|---|---|---|
| regulator · 2026-02-04 www.ftc.gov/news-events/news/press-releases/2026/02/ftc-secures-landmark-settlement-express-scripts-lower-drug-costs-american-patients | Claim 4 | Unassigned | corrected | “are expected to drive down patients' out-of-pocket costs for drugs like insulin by up to $7 billion over 10 years” Quote basis: not recorded. |
| regulator www.ftc.gov/terms/pharmacy-benefits-managers-pbm | Claim 5 | Unassigned | confirmed | “anticompetitive and unfair rebating practices” Quote basis: not recorded. |
Source vault
Link status: Candidate - not yet fetched
| Document | Last fetch | |
|---|---|---|
| Privacy policy express-scripts.com/legal/privacy-policy | Not fetched yet | NO (HTML only) |
| Terms of service express-scripts.com/legal/terms-of-use | Not fetched yet | NO (HTML only) |
| Website No URL recorded | Not fetched yet | — |
| Primary source https://www.ftc.gov/terms/pharmacy-benefits-managers-pbm Verification: Verified - primary source confirmed | Not fetched yet | — |
Enforcement
No enforcement actions are linked to this row.
State statute
No HQ state on file, so no state statute applies by headquarters.