The Express Scripts Standard Offering from the FTC settlement

Something good came out of the FTC’s settlement with Express Scripts that hasn’t gotten enough attention.

ESI is now required to offer every plan sponsor a Standard Offering: a baseline contract with net-price cost-sharing, a path off rebate guarantees and spread pricing, and no preferential treatment for high-list-price drugs over cheaper equivalents.

They have to sell it, too. The order requires at least $10 million a year in marketing.

Most of it takes effect January 1, 2027. Transparency and pharmacy reimbursement provisions follow by January 1, 2028. An independent monitor watches compliance for the first three years of a ten-year order.

Plan sponsors don’t have to accept the Standard Offering. But ESI has to offer it to everyone.

CVS Caremark filed a proposed settlement in March on terms analysts expect to mirror this one. If that holds, the Standard Offering framework covers two of the three largest PBMs in the country before your next renewal cycle.

That makes it a benchmark. A prudent fiduciary will need to be prepared to explain why they chose a PBM contract that fails to meet or exceed this standard. If they can’t, that’s worth a conversation with counsel.

Ask your PBM whether they’re prepared to offer equivalent terms. Or keep donating your margin to them.