Who Owns Express Scripts?

Express Scripts operates under Cigna's corporate sustainability framework. As a pharmacy benefits manager, the company's environmental impact is primarily related to its mail-order pharmacy operations, distribution logistics, and office facilities.

Environmental Operations: Express Scripts has implemented energy-efficient lighting, optimized HVAC systems, and recycling programs across its mail-order pharmacies and distribution centers. The company has committed to reducing energy consumption and greenhouse gas emissions in its pharmacy operations.

Sustainable Healthcare Delivery: Mail-order pharmacy services reduce patient travel emissions compared to retail pharmacy visits. Express Scripts' digital health platforms minimize paper usage, and its medication distribution systems are designed for efficiency.

Medication Waste Reduction: Express Scripts operates waste reduction programs for pharmacy operations, including packaging materials and expired medications. The company's clinical programs also aim to reduce medication waste through adherence monitoring and appropriate prescribing controls.

Ethical Business Practices: The FTC settlement in early 2026 imposed new ethical requirements on Express Scripts, including disclosure of payments to consultants or brokers who help employers choose PBMs, and reporting of drug spending data to employer clients. These requirements address long-standing concerns about conflicts of interest in the PBM industry.

Community Pharmacy Support: Under the FTC settlement, Express Scripts must move to a cost-plus reimbursement model for community pharmacies, paying them based on the actual cost of drugs plus a dispensing fee. This change is expected to bring millions of dollars in new revenue to independent pharmacies that have long complained about PBM reimbursement rates.

Express Scripts has received recognition throughout its 40-year history for pharmacy innovation and industry leadership.

Pharmacy Innovation: Express Scripts has been recognized by pharmacy organizations and healthcare publications for its pharmacy benefits management programs, specialty pharmacy services, and clinical interventions. The company's biosimilar adoption programs have been noted as a significant value driver in controlling specialty drug costs.

Technology and Digital Health: Express Scripts' technology infrastructure, which supports real-time claims processing, drug interaction checking, and formulary management, has received recognition from healthcare technology organizations. The new Signature model's technology platform, which surfaces the lowest price to members at the pharmacy counter, represents a significant innovation in PBM transparency.

Market Leadership: Express Scripts is consistently ranked as one of the three largest PBMs in the United States. The company processes approximately 1.5 billion prescriptions annually and serves tens of millions of members through employer, health plan, and government program contracts.

Regulatory Leadership: The FTC settlement and the proactive transition to the Signature rebate-free model have positioned Express Scripts as the first of the Big Three PBMs to move away from the traditional rebate model. Cigna has described this transition as aligning with regulatory expectations and employer fiduciary obligations.

FTC Insulin Pricing Lawsuit: In September 2024, the FTC sued Express Scripts, OptumRx, and Caremark, alleging that the PBMs' negotiating practices with drugmakers led them to prefer higher-cost drugs and drive up the cost of insulin. The FTC argued that Express Scripts' formulary design favored expensive insulin products over cheaper alternatives, increasing patient out-of-pocket costs. Express Scripts reached a settlement with the FTC in early 2026, agreeing to major changes in its business practices. The settlement required no financial penalties but imposed structural reforms including delinking compensation from drug prices, banning commercial spread pricing, and requiring benefit design based on net cost.

PBM Industry Scrutiny: Express Scripts has faced sustained criticism from lawmakers, patient advocacy groups, and independent pharmacies over PBM practices. Concerns include spread pricing, formulary manipulation, rebate retention, and reimbursement rates for community pharmacies. The Consolidated Appropriations Act and new PBM reform legislation have added disclosure requirements and compensation delinking rules that address many of these concerns.

Antitrust Concerns: The vertical integration of Express Scripts within Cigna's health insurance operations has drawn scrutiny from regulators and legislators examining whether integrated companies use PBM leverage to disadvantage competing health plans. The FTC's 2024 report on PBM practices highlighted the market concentration of the Big Three PBMs, which jointly control approximately 80% of U.S. prescriptions.

Data Privacy: Express Scripts handles sensitive patient health information and prescription data. The company has faced scrutiny over data privacy and security practices, particularly regarding compliance with HIPAA and healthcare information security regulations.

Classified Program Losses: In Q4 2024, Cigna reported $1.7 billion in losses related to classified programs within its defense health services business. While not directly related to Express Scripts, these losses affected Cigna's overall financial performance during the period preceding the FTC settlement.