WASHINGTON, D.C. – Rep. Earl L. “Buddy” Carter (R-GA) today released the following statement after the Federal Trade Commission (FTC) confirmed it has reached a historic settlement with Express Scripts, Inc. and its affiliated entities (collectively “ESI”) to bring down patients’ out-of-pocket costs for prescription drugs – including insulin – by up to $7 billion over the next decade, strengthen community pharmacies, and secure the Trump Administration’s health care priorities:
“Hours after we secured the largest PBM reforms for patients and pharmacists in decades, Chairman Ferguson and the FTC announced yet another win that will make health care more affordable and accessible. PBMs such as Express Scripts have been robbing us blind for years and are finally, under President Trump’s leadership, facing the consequences of their abuses. This administration is laser-focused on bringing relief to patients at the pharmacy counter, and the results speak for themselves. With this settlement, we will bring portions of our pharmaceutical supply chain back to America, increase transparency and accountability, and work towards a system in which all Americans have access to high-quality, affordable health care.”
ESI, under the FTC’s proposed consent order, has agreed to:
Stop preferring on its standard formularies high wholesale acquisition cost versions of a drug over identical low wholesale acquisition cost versions;
Provide a standard offering to its plan sponsors that ensures that members’ out-of-pocket expenses will be based on the drug’s net cost, rather than its artificially inflated list price;
Provide covered access to TrumpRx as part of its standard offering upon relevant legal and regulatory changes;
Provide full access to its Patient Assurance Program’s insulin benefits to all members when a plan sponsor adopts a formulary that includes an insulin product covered by the Patient Assurance Program unless the plan sponsor opts out in writing;
Provide a standard offering to all plan sponsors that allows the plan sponsor to transition off rebate guarantees and spread pricing;
Delink drug manufacturers’ compensation to ESI from list prices as part of its standard offering;
Increase transparency for plan sponsors, including with mandatory, drug-level reporting, providing data to permit compliance with the Transparency in Coverage regulations, and disclosing payments to brokers representing plan sponsors;
Transition its standard offering to retail community pharmacies to a more transparent and fairer model based on the actual acquisition cost for a drug product plus a dispensing fee and additional compensation for non-dispensing services;
Promote the standard offerings to plan sponsors and retail community pharmacies; and
Reshore its group purchasing organization Ascent from Switzerland to the United States, which will bring back to the United States more than $750 billion in purchasing activity over the duration of the order.
