UPDATED: Feb. 4 at 12:06 p.m. ET
The Federal Trade Commission and Cigna's Evernorth unit have officially reached a settlement that resolves allegations that the company's pharmacy benefit manager artificially drove up prices for insulin.
As part of the settlement, Evernorth's Express Scripts has agreed to several key business changes that are designed to reduce insulin prices significantly, the FTC said in a press release. The PBM will stop listing preferred drugs at the high wholesale acquisition cost rather than lower cost versions on its standard formularies, and will offer access to Trump Rx's direct-to-consumer platform as part of its standard offerings.
In addition, Express Scripts agreed to establish a standard offering for plan sponsors where the out-of-pocket costs for patients are based on the net cost of a drug, rather than the list price. It will also provide full access to its Patient Assurance Program to all individuals if insulin is on a formulary, unless the plan sponsor chooses to opt out.
Other changes include offering a standard benefit design that allows plan sponsors to transfer off of rebates or spread pricing, and delinking drug manufacturers' payouts from list prices in standard benefits.
The company also agreed to reshore its group purchasing organization, Ascent, from Switzerland to the United States.
The original FTC complaint, which was filed against Express Scripts as well as the other two firms that make up the "Big Three" PBMs, Optum Rx and CVS Caremark, alleged that the companies inflated insulin costs by preferencing rebates. This model pushed drugmakers to compete for formulary placement through rebates rather than net price for insulin.
Express Scripts said in a statement to Fierce Healthcare that the agreement is designed to ensure that its members pay the lowest cost for their prescriptions. The PBM announced in October that it would roll out a new, rebate-free model that puts greater transparency at the center.
Company leaders have said they expect to take a significant financial hit from the launch of this new model.
"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," the company said in the statement. "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," Express Scripts said.
The settlement will be available for public comment for 30 days. It's unclear if the FTC is pursuing similar agreements with Optum Rx and Caremark, and where those conversations may be. The companies sought to have the case dismissed amid turnover on the commission as the Trump administration took office a year ago.
PUBLISHED: Jan. 22 at 3:40 p.m. ET
The Federal Trade Commission (FTC) and Evernorth may be on the cusp of a settlement to resolve allegations that the company's pharmacy benefit management arm artificially inflated insulin prices.
The FTC said in a court filing (PDF) issued earlier this week that it would suspend the administrative case against Express Scripts, Evernorth's PBM, and Ascent Health, its group purchasing organization. Evernorth is a subsidiary of the Cigna Group and a sister to the Cigna Healthcare insurance arm.
In the filing, the agency said it was suspending the case for 14 days "for the purpose of considering a proposed consent agreement." The two weeks will allow the FTC to engage in key negotiations with Evernorth and "engage in parallel settlement discussions with other respondents."
Alongside Evernorth, the FTC filed suit against UnitedHealth Group's PBM Optum Rx and GPO Emisar Pharma Services as well as CVS Health's Caremark PBM and GPO Zinc Health Services. In that complaint, filed in September 2024, the FTC alleged that these firms "rigged" the pharmaceutical supply chain to drive up costs.
The three companies countersued in November 2024, arguing that the administrative process was unlawful.
“This sweeping attempt to reshape an entire industry via law enforcement would never pass muster in a U.S. District Court,” they said in the lawsuit.
The health insurers also filed a motion to dismiss the case in September 2025, arguing that the complaint failed to prove unfair competition and noting that the case had been under a lengthy stay following a change in the makeup of the commission under the Trump administration.
What a settlement deal may look like is unclear based on the court documents, and it's also unclear as of now whether the agency is similarly close to an agreement with CVS or UnitedHealth.
An FTC spokesperson declined to comment on a potential settlement. Evernorth had not responded to a request for comment at the time of publication.
Editor's note: This story was updated to include a response from the FTC.