Cigna to Remedy Years of Unfair Business Practices with Patients and Pharmacies

Health care giant Cigna recently settled a lawsuit with the Federal Trade Commission (FTC) to resolve the effects of their business practices over the years, according to a news release from the National Community Pharmacists Association (NCPA).¹ The FTC, working closely with key stakeholders impacted by Cigna, specifically targeted the company’s dealings focused on driving up patients’ drug costs and impeding pharmacy competition.

“This settlement will help lower consumers’ copays that have been tied to artificially inflated prices that feed Cigna’s insatiable appetite for more and more rebates and group purchasing organization (GPO) fees,” said NCPA CEO B. Douglas Hoey, RPh, MBA.¹ “The settlement also obliterates the big PBM industry fiction that they work to lower the cost of drugs for Americans.”

While this decision indeed opens the door for an even greater look into the business practices of large health care corporations, it was hyper-focused on the practices of Cigna’s affiliated pharmacy benefit manager (PBM) known as Express Scripts. Even more specifically, the major PBM—which is 1 of 3 that accounts for roughly 80% of all retail pharmacy prescriptions—was held accountable for its role in driving up insulin prices.^2,3

READ MORE: What the Newest Landmark PBM Reform Means for the Pharmacy Industry

According to the American Journal of Managed Care, the FTC first raised the lawsuit in September 2024, which was then followed by a PBM-led lawsuit from the 3 major PBMs—Express Scripts, CVS Caremark, and OptumRx.⁴ Serving as welcoming news for patients and independent pharmacies, this announcement demonstrates continued trends of PBM reform and accountability as of late.

Details of the FTC-Express Scripts Settlement

“For years, out-of-pocket costs for patients were driven by artificially high list prices and convoluted rebate games,” FTC Chair Andrew Ferguson told Reuters.⁵ “That ends with this settlement.”

Reports state that the 2 entities agreed to a 10-year plan where Express Scripts would pay out up to $7 billion aimed at patient savings on out-of-pocket (OOP) prescription drugs and insulin costs.^2,5 Further highlighting the “landmark” descriptor of this settlement, Cigna is also going to be expected to significantly overhaul Express Scripts’ business practices and avoid any potential patient or pharmacy downfalls in the future.

On top of its financial penalties, Express Scripts and the greater Cigna organization committed to a cost-plus pharmacy reimbursement model that would pay participating pharmacy businesses for the drug acquisition costs as well as fixed fees for professional servicing. The company also agreed to eliminate any business dealings focused on spread pricing, which is the practice of charging insurers more for a drug than the PBM pays pharmacies.²

Aside from the PBM sector of Cigna’s business, the company is also required to “reshore” its GPO, Ascent Health Services, from Switzerland to the US. Finally, the settlement also mandated that Express Scripts begin offering access to and getting fully on board with the newly launched, direct-to-consumer TrumpRx website.

Introducing a New Approach to Pharmacy Benefits, Drug Distribution

While the settlement is another piece in the current presidential administration’s fight to lower patients’ drug costs, independent pharmacy is yet another significantly notable winner amid all of these developments.

“The cost-plus model element is very important,” continued NCPA’s Douglas Hoey.¹ “The big insurers and their PBMs are notorious for reimbursing pharmacies at rates below their operating costs, which causes them to lose money and ultimately go out of business.”

Similar to recent PBM reform signed into law by President Trump, this FTC-Cigna agreement and the news surrounding it show that independent pharmacy is well on its way to achieving the variety of reforms they’ve been advocating for across the past few decades and beyond. While these entities may actively realize the benefits of these announcements more so than patients, all of these developments are focused on getting relief toward the continuous challenge of making US drug costs more affordable.

Experts will keep a close eye on the actions of Cigna and Express Scripts following this announcement, as independent pharmacies too will be significantly attentive regarding how the agreement is facilitated and what other legislative changes it could inspire.

“We don’t yet know the details, but it’s critical that pharmacies are reimbursed at a level that covers their cost of acquiring, dispensing, and monitoring medicines and leaves them with a reasonable profit,” concluded Hoey.¹ “We look forward to more details on this element of the agreement.”

READ MORE: Q&A: PBMs, Community Pharmacy’s Next Move Following PBM Reform Signing

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REFERENCES

1. Boom! FTC squeezes concessions from Cigna’s Express Scripts. News Release. NCPA. February 4, 2026. Accessed February 10, 2026. https://ncpa.org/newsroom/news-releases/2026/02/04/boom-ftc-squeezes-concessions-cignas-express-scripts

2. Landmark settlement: The Cigna group resolves FTC insulin pricing suit, reshaping the PBM landscape. Financial Content. February 9, 2026. Accessed February 10, 2026. https://markets.financialcontent.com/stocks/article/marketminute-2026-2-9-landmark-settlement-the-cigna-group-resolves-ftc-insulin-pricing-suit-reshaping-the-pbm-landscape

3. Laurent A. The Big 3 PBMs: an analysis of market share & dominance. Intuition Labs. November 8, 2025. Accessed February 10, 2026. https://intuitionlabs.ai/pdfs/the-big-3-pbms-an-analysis-of-market-share-dominance.pdf

4. Shaw ML. Express Scripts avoids fines but agrees to major structural overhaul. AJMC. February 5, 2026. Accessed February 10, 2026. https://www.ajmc.com/view/express-scripts-avoids-fines-but-agrees-to-major-structural-overhaul

5. Godoy J. Exclusive: Cigna settles FTC insulin case, aims to lower drug prices. Reuters. February 4, 2026. Accessed February 10, 2026. https://www.reuters.com/world/cigna-settles-ftc-insulin-case-commits-overhauling-drug-pricing-2026-02-04/