Express Scripts Comments on FTC's Reckless Insulin Action

Rhea-AI Summary

Express Scripts, a subsidiary of The Cigna Group (NYSE: CI), has responded to the Federal Trade Commission's (FTC) recent action on insulin. Andrea Nelson, Chief Legal Officer of The Cigna Group, criticized the FTC's move as part of a pattern of unsubstantiated attacks on pharmacy benefit managers. Express Scripts argues that the FTC's action, if successful, could drive drug prices higher by forcing PBMs to include drugs on formularies regardless of cost or clinical necessity.

The company intends to vigorously defend itself to protect its ability to lower drug costs for clients and consumers. Express Scripts highlighted its 2019 initiative to cap out-of-pocket costs for insulin at $25 for a 30-day supply, predating government action. The company also referenced its recent lawsuit against the FTC, demanding the retraction of what it calls a flawed report on pharmacy benefit managers.

Positive

• Express Scripts capped out-of-pocket costs for insulin at $25 for a 30-day supply in 2019
• The company is committed to defending its ability to lower drug costs for clients and consumers
• Express Scripts serves thousands of clients and millions of Americans

Negative

• FTC's action could potentially force PBMs to include higher-cost drugs on formularies
• The company is facing legal challenges from the FTC
• Ongoing regulatory scrutiny and potential legal battles may impact business operations

Insights

Legal Expert

The FTC's action against Express Scripts represents a significant legal challenge to the pharmacy benefit manager (PBM) industry. This lawsuit could have far-reaching implications for how PBMs operate and negotiate drug prices. Express Scripts' strong rebuttal and intent to "vigorously defend itself" suggests a protracted legal battle ahead.

The company's argument that the FTC's action could paradoxically increase drug prices by forcing PBMs to include higher-cost drugs on formularies raises important questions about the unintended consequences of regulatory intervention in complex healthcare markets. This case may set a precedent for future regulation of PBMs and could reshape the landscape of drug pricing negotiations.

Healthcare Policy Analyst

Express Scripts' proactive approach to insulin pricing, implementing a $25 cap for a 30-day supply in 2019, demonstrates the industry's capacity for self-regulation. This move, predating government action, highlights the complex dynamics between private sector initiatives and public policy in healthcare.

The conflict between Express Scripts and the FTC underscores the ongoing debate about the role of PBMs in the US healthcare system. The outcome of this dispute could significantly impact future healthcare policy, potentially leading to increased scrutiny of PBM practices or, conversely, reinforcing their importance in cost containment. This case may become a catalyst for broader healthcare reform discussions.

Financial Analyst

This legal challenge poses a potential risk to Express Scripts and its parent company, The Cigna Group (NYSE: CI). If the FTC's action succeeds, it could disrupt the PBM business model, potentially impacting Cigna's revenue and profitability. Investors should monitor this situation closely, as it may have implications for the entire healthcare sector.

However, Express Scripts' strong market position and history of adapting to regulatory changes suggest it may be well-positioned to navigate this challenge. The company's proactive stance on insulin pricing could be viewed favorably by stakeholders. Long-term investors should consider the broader industry trends and potential for regulatory changes when evaluating Cigna and other companies in the PBM space.

Express Scripts was the first to cap out-of-pocket costs for insulin medications at $25 for a 30-day supply in 2019, well before the government took action

ST. LOUIS, Sept. 20, 2024 /PRNewswire/ -- Express Scripts by Evernorth, a subsidiary of The Cigna Group (NYSE: CI), today issued the following statement in response to the Federal Trade Commission's reckless insulin action:

Attributable to Andrea Nelson, Chief Legal Officer, The Cigna Group:

"This action continues a troubling pattern from the FTC of unsubstantiated and ideologically-driven attacks on pharmacy benefit managers, following the FTC's biased and misleading July 2024 report, which Express Scripts demanded the Commission retract earlier this week. Once again, the FTC – a government agency funded by taxpayer dollars – is proving that the FTC does not understand drug pricing and instead is choosing to ignore the facts and score political points, rather than focus on its duty to protect consumers.

"The fact is that in the unlikely event the FTC succeeds in its suit and forces PBMs to include drugs on formulary even if they have higher net costs for plan sponsors – and regardless of whether they are clinically necessary – the FTC will drive drug prices higher in this country. This will hurt consumers and those who provide their prescription drug benefits – including employers, labor unions, and the federal government itself.

"Express Scripts intends to vigorously defend itself to protect our ability to lower drug costs for the thousands of clients and the millions of Americans we serve. In a world where pharmaceutical manufacturers continue to raise the price of medications every year, Express Scripts' work is more important than ever, and we won't allow baseless suits and false information to deter us from our mission."

Facts about Express Scripts and insulin can be found here. Additional information about Express Scripts' lawsuit filed against the FTC on September 17 to demand the retraction of its flawed and unsubstantiated report on pharmacy benefit managers can be found here.

About Evernorth Health Services
Evernorth Health Services creates pharmacy, care and benefits solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Evernorth capabilities are powered by our businesses, including Express Scripts, Express Scripts® Pharmacy, Accredo, eviCore and MDLIVE, along with holistic Evernorth platforms and solutions that move people and organizations forward. All Evernorth solutions are serviced and provided by or through operating affiliates of Evernorth Health, a wholly owned subsidiary of The Cigna Group (NYSE: CI), or third-party partners. Learn more at evernorth.com.

Media Contact
Justine Sessions
860-810-6523
justine.sessions@evernorth.com 

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SOURCE Express Scripts

FAQ

What action did Express Scripts take regarding insulin costs in 2019?

Express Scripts capped out-of-pocket costs for insulin medications at $25 for a 30-day supply in 2019, before government action on the issue.

How is Express Scripts (CI) responding to the FTC's insulin action?

Express Scripts intends to vigorously defend itself against the FTC's action to protect its ability to lower drug costs for clients and consumers.

What potential impact does Express Scripts claim the FTC's action could have on drug prices?

Express Scripts argues that if the FTC succeeds in forcing PBMs to include higher-cost drugs on formularies, it could drive drug prices higher in the country.

What legal action has Express Scripts taken against the FTC recently?

Express Scripts filed a lawsuit against the FTC on September 17, 2024, demanding the retraction of what it calls a flawed and unsubstantiated report on pharmacy benefit managers.