FTC Proposes Consent Order With Express Scripts to Overhaul Insulin Pricing Incentives

Overview

• Announced on February 4, the proposed settlement would prohibit Express Scripts from preferencing higher list-price drugs over identical lower-priced versions on its standard formularies.
• Express Scripts would be required to offer plan designs that base member cost sharing on net cost rather than list price, with standardized offerings that create a path away from rebate guarantees and spread pricing.
• The order would mandate drug-level reporting to plan sponsors, data to support federal Transparency in Coverage compliance, and disclosures of payments to employer brokers.
• Express Scripts would relocate its Switzerland-based group purchasing entity, Ascent, to the United States, which the FTC estimates would repatriate more than $750 billion in purchasing activity over the order’s term.
• The proposal is open for a 30-day public comment period and, if finalized, would remain in effect for 10 years with an independent monitor for the first three years; no settlements have been announced with Caremark Rx or OptumRx.