FTC Secures Settlement With Express Scripts to Lower Drug Costs     

This article was exclusively distributed to subscribers on February 9, 2026. Click to receive additional information about how to subscribe and to activate a complimentary trial subscription.

On February 4, the Federal Trade Commission (FTC) a landmark settlement with Express Scripts and three of its affiliated entities. The proposed formalizing the settlement partially resolves an the FTC lodged in 2024 against Express Scripts, along with Caremark Rx and OptumRx, two other major PBMs. The FTC’s Administrative Complaint alleged that the three PBMs “manipulat[ed] drug price competition for their own gain,” by, among other things, artificially inflating the list prices of insulin drugs, “leading to artificially inflated list prices that are disconnected from the actual cost of the drugs to insurers.” If finalized, the FTC settlement would impose sweeping restrictions across Express Scripts’ formulary, pricing, and compensation practices beyond just insulin pricing.

In its press release, the FTC projected that the Express Scripts settlement will result in up to $7 billion in patient savings over ten years. The proposed settlement is subject to a 30-day public comment period. Implementation timelines run through January 2028, with formal monitoring for three years and ongoing compliance reporting to the FTC. Meanwhile, the FTC is continuing its Administrative Proceeding against Caremark Rx and OptumRx.

This settlement comes on the heels of several recent federal actions related to PBM transparency, including a Department of Labor (DOL) that would require PBMs to disclose all compensation streams to Employee Retirement Income Security Act (ERISA) plan fiduciaries, with audit rights and enforcement. That rule is aimed at all self-insured private employer plans, not just those administered by Express Scripts. Meanwhile, the recently passed Consolidated Appropriations Act (CAA), 2026 () includes Medicare Part D compensation delinking and PBM transparency requirements, making this a particularly active moment for PBM regulation and drug pricing practices. Together with this settlement, these three actions create overlapping pressure on PBM business models across commercial, employer, and government markets.

For more on the DOL proposed rule, Manatt on Health subscribers can see the Manatt on Health

For more on the CAA, 2026 provisions, Manatt on Health subscribers can see the Manatt on Health

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