Cigna/Express Scripts Settlement: NCPA Cheers FTC Action on Drug Prices & Pharmacy Competition

ALEXANDRIA, Va. (Feb. 4, 2026) – The Federal Trade Commission’s (FTC) actions against Cigna’s Express Scripts have been met with approval from the National Community Pharmacists Association (NCPA). The agreement aims to address practices that have contributed to higher drug prices for consumers and challenges for independent pharmacies.

A Landmark Settlement

The FTC settlement requires Cigna’s Express Scripts to make several key changes. These include eliminating spread pricing, which is a practice where the difference between what a pharmacy is reimbursed and what the PBM pays is kept as profit. The agreement also requires decoupling rebates and fees from the list price of drugs.

Addressing Transparency and Competition

Cigna’s Group Purchasing Organization (GPO), Ascent, will be required to relocate from Switzerland to the U.S. And will be subject to FTC monitoring for the next 10 years. The settlement also mandates a shift to a cost-plus model for reimbursing independent pharmacies – those with three or fewer locations – in commercial plans, starting in 2027 or sooner.

Did You Know? The NCPA has been in communication with FTC staff for years, providing information on practices that reduce competition, limit patient access, and increase drug prices.

NCPA CEO B. Douglas Hoey stated the settlement “will help lower consumers’ copays that have been tied to artificially inflated prices.” He also expressed hope that Here’s “only the beginning of righting the games leading to higher drug prices and harming competition.”

Impact on Pharmacies and Employers

Matt Seiler, NCPA General Counsel, noted that the settlement could cause significant financial harm to Cigna’s Express Scripts. He also stated that more work is needed to address drug pricing and reimbursement in Medicaid, Medicare, and Tricare. The NCPA believes employers should be aware of the FTC’s actions and understand how Cigna’s past practices may have affected their financial health.

Expert Insight: This settlement represents a significant step toward addressing concerns about the role of Pharmacy Benefit Managers (PBMs) in the pharmaceutical supply chain and their impact on drug costs and access. The required changes could reshape how independent pharmacies are reimbursed and potentially increase competition within the market.

Hoey emphasized the importance of the cost-plus model, stating that pharmacies need to be reimbursed at a level that covers their costs and allows for a reasonable profit. He also connected below-cost reimbursements to the emergence of “pharmacy deserts” – areas where pharmacies have closed, leaving patients without local healthcare providers.

Frequently Asked Questions

What does the settlement require of Cigna’s Express Scripts?

The settlement requires Cigna’s Express Scripts to eliminate spread pricing, decouple rebates and fees from the list price of drugs, relocate its GPO Ascent to the U.S., submit to FTC monitoring for 10 years, and adopt a cost-plus model for independent pharmacy reimbursement.

What is a “pharmacy desert”?

A pharmacy desert is an area where pharmacies have closed, leaving patients without a local healthcare provider. According to NCPA CEO B. Douglas Hoey, below-cost pharmacy reimbursements are a main driver of these deserts.

What does NCPA suggest employers do?

NCPA encourages employers to demand more from the brokers they hire to help them select drug benefit plans for their employees, because a healthy workforce depends on accessible pharmacies and lower drug costs.

As the details of the cost-plus reimbursement model are revealed, it will be important to assess whether it truly addresses the financial challenges faced by independent pharmacies and ensures sustainable access to care for communities across the country.