The news: Cigna Group’s pharmacy benefit manager (PBM), Express Scripts, recently sued the Federal Trade Commission (FTC), demanding a retraction of an agency report that criticized pharma’s middlemen.

• Express Scripts argues it’s been defamed by the report and is filing suit with the goal of having it removed from the FTC’s websites.

Zooming out: The report came on the heels of a two-year investigation by the FTC and alleges PBMs hold considerable sway over the drugs patients can access and the prices they pay for them.

• For context, the three largest PBMs (OptumRx, Express Scripts, and CVS Caremark) processed nearly 80% of the approximately 6.6 billion prescriptions dispensed by US pharmacies in 2023.
• Further, given vertical integrations with the US’ largest health insurers and retail and specialty pharmacies, PBMs also appear to be steering patients to affiliated pharmacies.
• When the report was issued, the FTC disclosed its plans to sue the three largest PBMs over their business practices for negotiating drug prices.

PBMs won’t back down: In a House Committee on Oversight and Accountability hearing that took place after the report’s release, executives from the three largest PBMs argued that they pass through nearly all rebates to plan sponsors and provide cost savings to consumers.