FTC report on PBMs ignores evidence while trumpeting false claims, Cigna says

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A federal report about business practices of pharmacy benefit managers (PBMs) is loaded with false and misleading claims that fail to serve the interests of American consumers, according to a new lawsuit.

Express Scripts by Evernorth, a subsidiary of The Cigna Group, filed a lawsuit demanding the Federal Trade Commission (FTC) retract its scathing report published in July.

"The FTC has taken unconstitutional actions in publishing a report that ignores the evidence provided by our company and other PBMs, demonstrates clear ideological bias and advances a false and damaging narrative – a narrative that could harm the health care system by removing essential checks and balances which would result in higher drug prices for American consumers," Cigna Chief Legal Officer Andrea Nelson said in a news release. "We don't take this step lightly, but as advocates working to lower drug prices for millions of Americans and the employers, labor unions, and government agencies that provide their prescription drug benefits, we cannot let the FTC's unlawful actions and false information stand."

Saving money

The Cigna Group announcement noted Express Scripts and other PBMs save money for consumers – $38 billion for Express Scripts clients in 2023. The company also argued a key point: “Drug manufacturers – not PBMs – set the prices of their drugs.”

Express Scripts announced the company has cooperated with the FTC’s study of PBMs, but the federal regulators are ignoring that information.

“The FTC's report disregarded the millions of documents and terabytes of data produced by Express Scripts and other PBMs,” Cigna’s news release said. “As a result, the report is riddled with false statements, misleading insinuations and violates the Commission's duty to follow due process and serve the public interest.”

Industry support

Cigna found support from the Pharmaceutical Care Management Association (PCMA), the industry trade group for PBMs. The FTC’s report falls far short of a definitive, fact-based assessment, PCMA President and CEO J.C. Scott said in a news release.

“Anecdotes and comments from anonymous sources and self-interested parties, supported only by cherry-picked case studies that are implied to be representative of the entire market, is damaging to our companies’ ability to rein in costs for the employers and patients we serve, driving costs up everywhere in the healthcare system and helping only Big Pharma,” Scott said. “The FTC has a history as an objective agency that relies on data and evidence. The FTC and Congress must not ignore the volumes of data that demonstrate the value that PBMs provide to America’s health care system by reducing prescription drug costs and increasing access to medications.”

More information

Cigna has developed a website with the news release and full text of its 58-page complaint. The lawsuit was filed in the U.S. District Court for the Eastern District of Missouri.

The PBM’s complaint was just one legal action within the same week involving PBMs and federal regulators. On Sept. 20, the FTC announced an administrative action against PBMs for allegedly manipulating insulin prices for years.