ST. LOUIS COUNTY, Missouri — Express Scripts, Inc. sued the Federal Trade Commission on Tuesday over a report the pharmacy benefit management company called “unfair, biased, erroneous and defamatory.”

Headquartered in North St. Louis County, Express Scripts, a subsidiary of The Cigna Group, is demanding the FTC retract a report it made in July 2024 that said the pharmacy benefit management industry drives up drug prices consumers pay.

Pharmacy benefit management companies, or PBMs, act as the middlemen between drug manufacturers, pharmacies and insurers. They negotiate the terms and conditions for access to prescription drugs and are often vertically integrated, with stakes in health insurance companies, retail pharmacies, health care clinics and the drug private labeling business.

The FTC’s interim report states that PBMs achieve high profits by inflating drug costs and squeezing independent pharmacies to the point of closure. And it names Express Scripts as one of the six largest PBMs, saying that given their size, the companies wield significant power in the market.

Express Scripts filed a lawsuit against the FTC Tuesday morning in the Missouri Eastern District of federal court. The suit also names FTC chair Lina Khan and says that the July 2024 report follows prejudice and politics, not evidence or sound economics.

“Express Scripts’ business and reputation have been harmed by the Commission’s unlawful, unconstitutional, and arbitrary and capricious conduct and defamatory statements,” reads the lawsuit. Express Scripts is asking for an unspecified amount of money.

In a news release, Express Scripts stated that drug manufacturers, not the PBMs, that set the prices of prescriptions. The company said it negotiates to lower the cost of drugs for insurance plans and has pioneered programs to shield customers from high prices.

“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,” said Andrea Nelson, chief legal officer for The Cigna Group, said in a statement.

FTC spokesperson Douglas Farrar said the federal agency stands by its study.

“Just three companies control nearly 80% of the market that millions of Americans must use to purchase necessary drugs at high costs,” he said in an email. “This is a complicated and opaque market, and the FTC is committed to using its clear authority to help the public and policymakers understand it."

Earlier this year, pharmacists and and advocates gathered at Express Scripts' headquarters to protest the company pushing independent pharmacies into unfavorable, “take-it-or-leave-it” contracts, and pressuring patients to switch to mail-order prescriptions.

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