Washington, DC, February 4, 2026 — The US Federal Trade Commission has secured a settlement with Express Scripts Inc. and its affiliated entities, resolving allegations that the company, one of the largest pharmacy benefit managers in the country, engaged in conduct that artificially inflated insulin list prices through rebating practices.
According to the FTC’s lawsuit, these practices impaired patient access to lower-priced products and shifted higher costs onto patients whose copays and coinsurance were tied to list prices.
Under the proposed consent order, Express Scripts has agreed to adopt wide-ranging changes to its business practices. These include ending the preference for higher wholesale acquisition cost versions of drugs over identical lower-cost versions, offering plan designs that base patient out-of-pocket costs on net prices rather than list prices, and delinking manufacturer compensation from drug list prices.
The settlement also requires Express Scripts to provide broader access to insulin benefits under its Patient Assurance Program, offer plan sponsors options to move away from rebate guarantees and spread pricin,g and transition reimbursement models for retail community pharmacies to a system based on actual acquisition costs plus dispensing fees and compensation for non-dispensing services.
The FTC said the changes are expected to reduce out-of-pocket drug costs for American patients by up to $7 billion over the next 10 years, while increasing transparency and revenues for community pharmacies.
“The FTC’s settlement with Express Scripts is a clear testament to the Trump-Vance FTC’s focus on lowering healthcare costs for American patients,” FTC Chairman Andrew N. Ferguson said, adding that the agreement would end practices that kept drug prices high and advance broader healthcare policy priorities.
As part of the settlement, Express Scripts has also committed to reshoring its group purchasing organization, Ascent, from Switzerland to the United States. The FTC said this move will bring more than $750 billion in purchasing activity back to the US over the duration of the order.
The Commission voted 1–0 to accept the consent agreement for public comment, with Commissioner Meador recused. The public will have 30 days to submit comments before the Commission decides whether to finalize the order, which would then carry the force of law.
