Express Scripts Sues FTC, Demands Withdrawal of PBM Report

Rhea-AI Summary

Express Scripts, a subsidiary of The Cigna Group (NYSE: CI), has filed a lawsuit against the Federal Trade Commission (FTC) in federal court in Missouri. The company demands the retraction of the FTC's July 2024 report on the pharmacy benefit management (PBM) industry, claiming it contains false and misleading information. Express Scripts argues that the report ignores evidence provided by PBMs, shows ideological bias, and could lead to higher drug prices for consumers.

The company states it has cooperated with the FTC study for over two years, providing extensive data and information. However, Express Scripts contends that the FTC disregarded this input, resulting in a report with inaccuracies. The lawsuit claims the report violates the Commission's duty to follow due process and serve the public interest.

Positive

• Express Scripts achieved approximately $38 billion in savings for clients last year
• The company passes through over 95% of all rebates and fees to client plan sponsors
• Express Scripts has pioneered programs to shield patients from high list prices

Negative

• The lawsuit could potentially damage Express Scripts' relationship with regulatory bodies
• The FTC's report, if not retracted, may negatively impact public perception of PBMs
• Legal costs associated with the lawsuit could affect the company's financial performance

FTC's July 2024 report makes unsubstantiated, false and biased claims about the PBM industry; fails to take into account the value that PBMs deliver to consumers and patients

ST. LOUIS, Sept. 17, 2024 /PRNewswire/ -- In a lawsuit filed in federal court in Missouri, Express Scripts by Evernorth, a subsidiary of The Cigna Group (NYSE: CI), demanded that the Federal Trade Commission ("FTC" or the "Commission") retract its July 2024 report, which is filled with false and misleading claims about the pharmacy benefit management (PBM) industry and fails to serve the interests of American consumers.

Information about Express Scripts' lawsuit to protect those it serves is available at https://www.evernorth.com/advocate.

"The FTC has taken unconstitutional actions in publishing a report that ignores the evidence provided by our company and other PBMs, demonstrates clear ideological bias and advances a false and damaging narrative – a narrative that could harm the health care system by removing essential checks and balances which would result in higher drug prices for American consumers," said Andrea Nelson, Chief Legal Officer for The Cigna Group. "We don't take this step lightly, but as advocates working to lower drug prices for millions of Americans and the employers, labor unions, and government agencies that provide their prescription drug benefits, we cannot let the FTC's unlawful actions and false information stand."

For more than two years, Express Scripts fully cooperated with the FTC study into the PBM industry, meeting the agency's extensive demands for data and information. The FTC's report disregarded the millions of documents and terabytes of data produced by Express Scripts and other PBMs. As a result, the report is riddled with false statements, misleading insinuations and violates the Commission's duty to follow due process and serve the public interest.

The Facts About How Express Scripts Lowers the Cost of Prescription Drugs

"Our 18,000 Express Scripts colleagues work every day to improve health and lower the cost of medications for the millions of Americans we serve," said Eric Palmer, President and CEO of Evernorth Health Services. "Our clinicians and clinical programs perform thousands of critical medication safety checks on each prescription, and we are constantly innovating to improve medication access and affordability. 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 let misinformation or false accusations deter us from our mission." 

Express Scripts and other PBMs only exist because they provide real value, driving lower net drug costs for employers, labor unions and other plan sponsors and their members. Express Scripts achieved approximately $38 billion in savings for clients last year alone.

• Drug manufacturers – not PBMs – set the prices of their drugs. According to a Reuters analysis of 47 medicines, the median annual list price for a new drug was $300,000 in 2023, up from $222,000 in 2022.
• Express Scripts negotiates with drug manufacturers to lower the net cost of drugs for plan sponsors. Numerous academic and government studies and investigations, including several by the Commission, have demonstrated and quantified the magnitude of these savings to plan sponsors and patients. 
• Express Scripts has pioneered programs to shield patients from high list prices; supporting access to lower-cost generics and biosimilars; and providing customers with convenient access to personalized information about the cost of their care to help them make more informed decisions.

There is no support for claims that PBMs are responsible for high drug costs.

• There is no evidence that the alleged power of PBMs has been increasing over time.
• Express Scripts passes through over 95% of all rebates and fees it receives to its client plan sponsors.
• PBMs have no incentive to see list prices rise. List prices for branded drugs with rebates have grown less, not more, than list prices for branded drugs with no rebates.

For more information about Express Scripts' work to make medications more affordable and accessible, visit https://www.evernorth.com/express-scripts-facts.

An overview of Express Scripts' complaint, which argues the Commission's report violates the U.S. Constitution and federal law, and the full text are available 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

Why is Express Scripts (CI) suing the FTC in September 2024?

Express Scripts is suing the FTC to demand the withdrawal of the July 2024 report on the PBM industry, claiming it contains false and misleading information that could harm the healthcare system and lead to higher drug prices for consumers.

What savings did Express Scripts (CI) achieve for clients in 2023?

Express Scripts reported achieving approximately $38 billion in savings for its clients in 2023.

What percentage of rebates and fees does Express Scripts (CI) pass through to clients?

According to the press release, Express Scripts passes through over 95% of all rebates and fees it receives to its client plan sponsors.

How does Express Scripts (CI) claim to impact drug prices?

Express Scripts claims to negotiate with drug manufacturers to lower the net cost of drugs for plan sponsors and has pioneered programs to shield patients from high list prices.