The Federal Trade Commission (FTC) recently announced a proposed consent agreement with Express Scripts regarding alleged price inflation of insulin. In a new insight, Director of Health Care Policy Michael Baker discusses the significance of this agreement.

Key points:

• In 2024, the FTC filed an administrative complaint against the three largest PBMs – CVS Caremark, Express Scripts (owned by Cigna), and Optum Rx (owned by UnitedHealth Group) – and affiliated rebate/group purchasing organization (GPO) entities.
• The consent agreement settling the complaint covers a wide range of remedies that Express Scripts et al. must implement, including a restructuring of their proprietary formulary, pass through of net pricing to employer plans, improved business transparency, and – in a surprising inclusion – a commitment to counting member payments made through TrumpRx toward plan deductibles.
• While legally permissible, the overarching construct of this settlement creates several concerning ripple effects in what is a highly regulated market and does nothing to alleviate underlying cost and price issues in health care.

Read the analysis.