FTC Probes Express Scripts Deal for Market Fairness
Published Date: 2/12/2026
Notice
Summary
The Federal Trade Commission is reviewing a deal with Express Scripts and others to stop unfair business practices. This affects healthcare companies and could change how they compete, aiming for a fairer market. People have until March 16, 2026, to share their thoughts before the deal is final.
Analyzed Economic Effects
9 provisions identified: 8 benefits, 0 costs, 1 mixed.
Caps member costs to a drug's net price
If a plan sponsor adopts Express Scripts' required "standard offering," members' out-of-pocket costs for drugs must be no higher than the drug's net cost and cannot be tied to a higher list price. The Proposed Order requires this protection in the standard offering and says Cigna's fully‑insured health plans must adopt the same protections.
Cigna fully‑insured plans must adopt protections
All of Cigna's fully‑insured health plans are required by the Proposed Order to adopt the patient cost protections that limit member out-of-pocket costs to no more than a drug's net cost.
Pass rebates to members at point of sale; ban spread pricing
Under the standard offering, ESI must enable members to receive the benefit of any rebate or discount at the pharmacy point of sale (without charging a fee beyond actual pre‑funding costs), may not provide plan sponsors with rebate guarantees, and may not use spread pricing where the PBM charges a different amount than it reimburses pharmacies.
Pay small retail pharmacies actual cost plus fee
ESI must offer a standard contract to retail community pharmacies (businesses with three or fewer retail stores) that compensates them based on their actual drug acquisition cost plus a dispensing fee, pays extra for non‑dispensing services, and does not exclude any retail community pharmacy willing to accept the terms.
Insulin Patient Assurance Program access
If a plan sponsor adopts a formulary that includes an insulin product covered by ESI's Patient Assurance Program, ESI must provide full access to that Program for all members unless the plan sponsor opts out in writing, offering extra protection against high out‑of‑pocket insulin costs.
Require low‑WAC drug versions on formularies
ESI must place low‑WAC (lower list‑price) versions of drugs on its four standard commercial formularies without disadvantaging them compared to high‑WAC versions, except when the low‑WAC version is higher net cost or unavailable in sufficient supply. The change is intended to address situations where list‑price choices increased patients' out‑of‑pocket costs.
Require annual drug cost and claims transparency
ESI must provide plan sponsors as part of its standard offering an annual report showing each drug's costs, pharmacy claim‑level reporting, and any compensation paid to consultants or brokers related to pharmacy benefit services.
Delink manufacturer pay from list price
For ESI's standard offering, compensation from drug manufacturers to ESI may not be based, directly or indirectly, on a drug's list price (WAC). The change is intended to remove incentives tied to higher list prices.
Reshore ESI's group purchasing organization
The Proposed Order requires ESI to move its group purchasing organization (GPO) Ascent from Switzerland to the United States.
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