Antitrust enforcement action where the FTC settled with Express Scripts, a major pharmacy benefit manager, for using anticompetitive rebating practices that artificially inflated insulin prices. The settlement requires ESI to change its business practices to increase transparency and lower patient out-of-pocket costs, potentially saving $7 billion over 10 years.
Express Scripts must stop preferring high-cost drug versions, base member out-of-pocket costs on net price, provide standard offerings to plan sponsors, increase transparency with drug-level reporting, transition pharmacy payments to a cost-based model, reshore its group purchasing organization, and promote these standard offerings.
In-house legal teams should review all Pharmacy Benefit Manager (PBM) contracts, including agreements with health plans/insurers, pharmaceutical manufacturers, and network pharmacies. Specific clauses to scrutinize are those governing rebate structures and calculations, formulary placement and tiering logic, transparency reporting requirements, and provisions that restrict patient access to lower-cost alternatives (e.g., anti-tying or exclusionary clauses). Changes may be needed to remove anti-competitive terms, mandate full rebate pass-through to plans/patients, require clear disclosure of pricing and spread calculations, and ensure formulary decisions are based on clinical efficacy and net cost rather than rebate size. Contracts should also be amended to grant robust audit rights and prohibit 'gag clauses' that prevent pharmacies from informing patients about lower-cost cash pricing options.
Entity
Express Scripts, Inc.
Also known as: Express Scripts
Industry
HealthcareOfficial Press Release
https://www.ftc.gov/news-events/news/press-releases/2026/02/ftc-secures-landmark-settlement-express-scripts-lower-drug-costs-american-patients
d09437caremarkproporder esiresps
https://www.ftc.gov/system/files/ftc_gov/pdf/d09437caremarkproporder-esiresps.pdf
express scripts inc et al analysis of agreement containing c
https://www.federalregister.gov/documents/2026/02/12/2026-02844/express-scripts-inc-et-al-analysis-of-agreement-containing-consent-order-to-aid-public-comment
ftc sues prescription drug middlemen artificially inflating
https://www.ftc.gov/news-events/news/press-releases/2024/09/ftc-sues-prescription-drug-middlemen-artificially-inflating-insulin-drug-prices
Federal Trade Commission Enforcement Page
https://www.ftc.gov/enforcement
"Express Scripts, Inc., and its affiliated entities (collectively “ESI”)"
"The FTC’s enforcement action against ESI, as well as Caremark Rx and OptumRx, alleges that the PBMs created a system that artificially drove up the list prices of drugs by preferencing rebates."
The FTC, Utah, and Nevada sued Lens.com Inc., alleging that it advertised artificially low contact lens prices while hiding mandatory checkout charges and misleading consumers about its AutoRefill subscription. The complaint seeks to stop the alleged practices; the court has not yet decided the case, and no penalty or remedy has been imposed.
The FTC issued an advance notice of proposed rulemaking seeking public comment on whether ad-optimization tools offered by online platforms may help scammers impersonate businesses and government agencies. This is a proposed regulatory inquiry, not an enforcement action against a named company; no penalty or remedy was imposed.
$2.5B
A federal court approved a revised order in the FTC's Amazon Prime case under which Amazon will accelerate and expand redress payments under the September 2025 $2.5 billion settlement, which resolved allegations that Amazon enrolled millions of consumers in Prime subscriptions without their consent and knowingly made cancellation difficult. More consumers now qualify for refunds, the maximum payment cap rises from $51 to $200, and all future payments will be distributed automatically starting October 1, 2026, with potential supplemental $149 payments by April 2027. Amazon has already issued more than $845 million in redress payments as of September 2026.
$225.0M
The FTC and the state of Washington filed a joint complaint and proposed stipulated order requiring Amway Corp. and two affiliates—World Wide Group, L.L.C. (WWG) and Leadership Team Development Inc. (LTD)—to pay a $225 million judgment, the largest monetary recovery ever obtained from an MLM in an FTC action, over allegations that they used deceptive earnings claims and unfair tactics to recruit Independent Business Owners. The complaint alleges the companies falsely promised substantial income and recruitment success, pressured IBOs to buy products they could not resell, and instructed IBOs to falsely report sales. Nearly all of the judgment will be used as redress for IBOs who lost money, and the proposed order imposes structural reforms including a 70% resale requirement, independent audits of sales records, and a ban on approved providers charging new IBOs for first-year training.
$100.0M
FleetCor Technologies Inc. (now Corpay Inc.) and its CEO Ronald Clarke agreed to pay $100 million to settle an FTC administrative action alleging the company charged small business customers hidden and unauthorized fees for fuel cards and misrepresented gas savings, fraud-control features, and fees. A federal district court granted the FTC summary judgment on all counts in 2023, and a federal appeals court upheld that judgment and the permanent injunction in 2026. The settlement funds will be used to provide redress to harmed business customers.
FTC staff published FAQs on price transparency to help the automobile industry comply with the FTC Act, reiterating that an advertised vehicle price must be the actual price any consumer can pay, excluding only government-required charges. The guidance follows warning letters the FTC sent to 97 auto dealership groups earlier in 2026 and signals continued litigation against dealers that advertise one price but charge more through undisclosed fees. No specific entity was charged and no penalty was imposed.