Section 5 Soup: The Still-Secret Recipe to the FTC’s PBM Case
The Federal Trade Commission (FTC) just announced a “landmark” settlement with one of the nation’s largest pharmacy benefit managers (PBMs). The problem is that it doesn’t actually end the PBM case—and it raises as many questions as it answers.
In its settlement with Express Scripts Inc. (ESI) and its affiliated entities, the agency says the deal will force fundamental changes to ESI’s business practices, increase transparency, and reduce patients’ out-of-pocket drug costs—including insulin—by as much as $7 billion over 10 years. Perhaps it will, although they don’t show their work on that one. It also promises new revenue for community pharmacies and aligns, according to the FTC, with the Trump administration’s health-care priorities.
But here’s wrinkle number one: the FTC settled only part of a larger case.
On Sept. 20, 2024, the FTC filed a complaint against the three largest prescription-drug benefit managers—Caremark Rx, Express Scripts (ESI), and OptumRx—along with their affiliated group purchasing organizations (GPOs). The agency alleged anticompetitive and unfair rebating practices “that have artificially inflated the list price of insulin drugs, impaired patients’ access to lower list price products, and shifted the cost of high insulin list prices to vulnerable patients.”
Here’s the redacted complaint.
The new agreement resolves the claims against ESI and its affiliates alone. The cases against the other PBMs remain pending, and the FTC has said nothing yet about how—or whether—those will be resolved.