The FTC just projected $7 billion in future savings from forcing the Big Three to stop cheating. Do the math on what that means about the past.

The Pharmaceutical Care Management Association — the lobbying arm of the PBM industry — wants you to know that pharmacy benefit managers save patients and employers an average of $1,154 per person per year.[1] They’ve been saying some version of this for years. The number is on their website, in their congressional testimony, in their press releases, and in the mouths of their executives every time a legislator asks an inconvenient question.

So let’s take them at their word. And then let’s look at what the FTC just told us.

The Government’s Number

When the FTC settled with Express Scripts in February 2026, it announced that the required changes to ESI’s business practices are “expected to drive down patients’ out-of-pocket costs for drugs like insulin by up to $7 billion over 10 years.“[2] ESI controls roughly 23% of the commercial prescription market.[3] If Caremark and OptumRx settle on comparable terms — which appears likely — scale that number across 80% of the market. You’re looking at somewhere in the range of $24 billion in projected patient savings over the next decade, just from stopping practices the FTC alleged were illegal.

That’s $2.4 billion a year. Returned to patients. By stopping something that should never have happened.

The Question Nobody’s Asking

Here it is: if these changes will generate billions in patient savings going forward, what does that tell you about the years they weren’t making them?

The practices being ended — preferring high-list-price drugs to maximize rebates, calculating patient cost-sharing on inflated list prices instead of net prices, delinking compensation from actual drug value — these weren’t new in 2024. The FTC’s own complaint documents that insulin list prices climbed over 1,200% between 1999 and 2017 under exactly this system.[4] The rebate wall wasn’t built overnight. It was the industry’s operating model for decades.

The $7 billion in projected forward savings from one PBM is, implicitly, a confession about the past. It says: we had it in our power to structure benefits this way all along. We didn’t. Patients paid the difference.

The PCMA Math Problem

The industry’s lobby claims PBMs will save health plan sponsors and consumers more than $1.2 trillion on prescriptions over the 10-year period from 2025 to 2034.[1] That figure — like all PCMA figures — is generated by comparing actual drug spending to a hypothetical world without PBMs.

Notice what that math doesn’t ask: compared to what the same drugs would cost in a system where the PBMs weren’t running a rebate scheme that inflated list prices in the first place.

You can’t simultaneously claim credit for negotiating discounts off list prices and disclaim responsibility for the system that inflated those list prices. The PBMs built the mountain and are now charging for the rope.

What $7 Billion Actually Looks Like

ESI alone covers roughly 100 million lives.[3] Ten years. Seven billion dollars. That’s $70 per person per year in projected savings — on insulin pricing alone, from one PBM, going forward.

Now ask yourself: for every year those practices were in place, what was the per-patient cost? The FTC’s complaint documents that patients in deductible phases and on coinsurance paid out-of-pocket costs directly tied to inflated list prices. Not hypothetical patients. Not edge cases. Tens of millions of people, refilling prescriptions every month, paying more than they should have because a pricing system was deliberately engineered to extract that money from them.

The FTC’s $7 billion isn’t a win to celebrate in isolation. It’s a receipt.

Sources

  1. PCMA, “Value of PBMs” — https://www.pcmanet.org/value-of-pbms/

  2. FTC Press Release, “FTC Secures Landmark Settlement with Express Scripts to Lower Drug Costs for American Patients” (Feb. 4, 2026) — https://www.ftc.gov/news-events/news/press-releases/2026/02/ftc-secures-landmark-settlement-express-scripts-lower-drug-costs-american-patients

  3. AJMC, “Express Scripts Avoids Fines but Agrees to Major Structural Overhaul” (Feb. 2026) — https://www.ajmc.com/view/express-scripts-avoids-fines-but-agrees-to-major-structural-overhaum

  4. Goodwin Law, “Express Scripts Settles PBM FTC Action and Must Make Fundamental Changes to PBM Model” (Feb. 2026) — https://www.goodwinlaw.com/en/insights/publications/2026/02/alerts-lifesciences-antc-express-scripts-settles-pbm-ftc-action