The FTC has proposed settlements with two major drug middlemen

Federal regulators and state officials each took steps on different parts of the system that shapes GLP-1 access. The FTC has proposed settlements with two major pharmacy benefit managers, and neither is final yet. Twenty state attorneys general raised concerns with the Secretary of State about Chinese-made ingredients in compounded GLP-1 drugs, and new Medicaid data showed Pennsylvania's GLP-1 prescriptions falling sharply. Together, these moves bear on what you pay, what you receive, and whether your coverage holds.

Express Scripts acts as a middleman between insurers and pharmacies, negotiating which drugs get covered and at what price. On February 4, 2026, the FTC announced a proposed settlement with the company. The FTC voted to accept it for public comment, and it becomes a final order only after the Commission issues it on a final basis. Under the proposal, Express Scripts would base members' out-of-pocket costs on a drug's net cost rather than its list price, stop favoring high list price versions of a drug over identical lower-cost versions, and give plan sponsors more detail on pricing. The FTC's announcement focuses on insulin and does not mention GLP-1 drugs, so it is too early to say whether your GLP-1 costs will change. I would suggest checking with your pharmacy or insurer before expecting any difference at the pharmacy counter.

Caremark is the second major pharmacy middleman to reach a proposed settlement with the FTC this year. The July 14, 2026 proposal, with Caremark Rx and Zinc Health Services, was also accepted for public comment and is not final. It would require that members' out-of-pocket costs be no higher than the plan sponsor's contracted rate minus rebates, more pricing transparency for plan sponsors, and programs that cap what members pay for insulin. The FTC's announcement does not mention GLP-1 drugs. With two proposed settlements, the FTC appears to be treating pharmacy benefit managers as a central target in its effort to lower drug costs.

Tennessee Attorney General Skrmetti joined 19 other state attorneys general in a September 2026 letter to Secretary of State Marco Rubio about Chinese-sourced ingredients used in compounded GLP-1 drugs. The letter cites reports that some Chinese companies tied to fentanyl precursors are now selling weight-loss peptides, and it criticizes an FDA list of approved suppliers that the states say lets Chinese suppliers ship products without detention or inspection. These are concerns and allegations the states raised in a letter. Patients who buy GLP-1 drugs outside of a licensed pharmacy have no way to verify where the product came from or what it contains.

A larger coalition of 38 states and territories, co-led by Colorado, South Carolina, Illinois and Tennessee and joined by California, wrote to FDA in February 2025 urging faster action against counterfeit GLP-1 drugs, against online sellers of the active ingredients, and against compounders that cut corners. That letter is more than a year and a half old, so it is background rather than a new action. Its size shows that counterfeit GLP-1 drugs have been a concern across political and regional lines for some time.

Pennsylvania Medicaid spent $69.4 million on 68,509 GLP-1 prescriptions in the first quarter of 2026, down from $254.9 million in the last quarter of 2025, a decline that mirrors patterns in other states this year. In New Hampshire, Medicaid prescriptions for the weight-loss drugs Wegovy, Zepbound and Saxenda fell 88 percent over the same period, and in Puerto Rico they fell from 8,798 to none reported. These numbers suggest that some state Medicaid programs have narrowed coverage of GLP-1 drugs for weight loss rather than simply seeing less demand. Pennsylvania patients currently covered through Medicaid may want to confirm their coverage status directly with their plan.

The throughline across these developments is that drug pricing and drug safety are both being contested right now, through proposed federal settlements, state letters, and shifting Medicaid budgets. If you fill a GLP-1 prescription through Express Scripts or Caremark, these proposals do not change your costs today, and it is worth watching whether they become final. If you are considering a GLP-1 drug from a source outside your regular pharmacy, take the attorneys general's warnings about counterfeit and unregulated supply chains seriously and verify the source before you buy. None of these changes stem from one single action, but each shapes a different piece of what you pay and what you receive, and a short conversation with your pharmacist or insurer can clarify where you currently stand.

By Amanda Bonello