Express Scripts leads industry with comprehensive FTC settlement

BLOOMFIELD, Conn. — Express Scripts® leads the way for the pharmacy benefit industry as the first — and so far only pharmacy benefit manager (PBM) — to secure a comprehensive settlement with the FTC. Express Scripts believes this settlement will provide clarity and stability for our clients and consultant partners. We have been preparing for and communicating this new, more transparent model with consultants for months, and this agreement reinforces the steps we have already taken to lead the industry forward.

“Our priority is simple: lowering drug costs for Americans. This settlement enables us to keep moving forward, and we appreciate the Administration’s reinforcement of our commitment to pharmacy benefits that put Americans first. As enforced by the settlement, our new, transparent pharmacy benefits model ensures our members get their medicines at the lowest price — whether it’s the Express Scripts negotiated cost, their copay, or a cash discount price. We’ll also provide access to TrumpRx as part of our standard offering, upon relevant legal and regulatory changes, and purchases through TrumpRx will count toward our members’ deductibles and out-of-pocket maximums. This is a meaningful step toward affordability for millions of families, and toward advancing the goal we share with the Administration of full transparency into prescription drug costs. Today’s settlement charts a clear path forward for pharmacy benefits in America.”

The settlement includes meaningful actions to:

• Ensure that Express Scripts members pay the lowest available cost for their medicines, whether it is the Express Scripts negotiated cost, their copay, or a cash discount price. For example, Express Scripts will now integrate cash pricing available through TrumpRx into the benefit and count member payments made through TrumpRx toward their deductible, provided legislative or regulatory changes are made under the Medicaid Drug Rebate Program and Section 340B of the Public Health Service Act;
• Ensure more lower-priced medicines, including insulins, are covered across all Express Scripts standard formularies — and make the Patient Assurance Program that caps the monthly cost of insulin at $25 the standard for all Express Scripts clients;
• Ensure that Express Scripts’ industry-leading and transformative rebate-free model is widely available to employers and health plan sponsors to lower the cost of all brand medications for their members as our new standard model;
• Ensure that Express Scripts’ new reimbursement model based off the pharmacy’s actual acquisition costs is available to retail community pharmacies, and that retail community pharmacies are compensated for other essential clinical services (e.g., certain diagnostic testing and vaccinations); and
• Support the American economy by moving rebate contracting operations conducted on Express Scripts’ behalf to the U.S.