KEY DETAILS
A new FTC settlement forces Express Scripts, a major pharmacy benefit manager, to lower drug costs for patients starting now.
The FTC also settled with Caremark, requiring the pharmacy middleman to cut out-of-pocket costs and disclose more about how it prices drugs.
Twenty state attorneys general, including Tennessee's, are warning that counterfeit GLP-1 drugs from China may be linked to fentanyl precursor suppliers.
Thirty-eight state attorneys general are pressing the FDA to act quickly against counterfeit weight-loss drugs spreading across the market.
Pennsylvania Medicaid's GLP-1 spending and prescription counts dropped sharply in early 2026, pointing to possible new coverage restrictions for patients there.
Federal regulators and state officials each took action this week on different parts of the system that shapes GLP-1 access. The FTC settled with two major pharmacy benefit managers, ordering them to lower patient costs. Dozens of state attorneys general pressed the FDA to stop counterfeit weight-loss drugs from reaching patients, and new Medicaid data showed Pennsylvania's GLP-1 coverage narrowing sharply. Together, these moves affect 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, and the FTC's settlement means that role now comes with legal limits. The agency's action follows years of scrutiny into how pharmacy benefit managers handle rebates and fees, practices the FTC says have pushed drug costs higher than necessary. Because the settlement takes effect now, patients filling GLP-1 prescriptions through Express Scripts may start to see changes in what they owe at the pharmacy counter. The exact savings will vary by plan, so I would suggest checking with your pharmacy or insurer to understand how this affects your specific coverage.
Caremark is the second major pharmacy middleman the FTC has settled with this year, and the terms go further than cost cuts alone. Along with lowering what patients pay out of pocket, Caremark must now disclose more about how it sets drug prices, information that has historically stayed hidden from patients and even from the pharmacies that fill prescriptions. That disclosure requirement matters because pricing opacity has made it difficult for patients to know whether they are paying a fair price for a GLP-1 medication. With two settlements now in place, the FTC appears to be treating pharmacy benefit managers as a central target in its effort to lower drug costs nationwide.
Tennessee Attorney General Skrmetti joined nineteen other states in raising a concern that goes beyond simple counterfeiting. According to the coalition, some of the suppliers shipping fake GLP-1 drugs from China have also been tied to the chemicals used to make fentanyl, which raises questions about who is actually producing these counterfeit medications and what quality controls, if any, exist. 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. The states are pushing for closer scrutiny of these supply chains before counterfeit products spread further into the market.
California Attorney General Bonta led this larger coalition, which includes more than three-quarters of the states, arguing that the FDA has not moved quickly enough against counterfeit weight-loss drugs already circulating. Colorado Attorney General Phil Weiser raised a similar call separately, pointing to the volume of fake product reaching consumers outside regulated supply chains. The size of this coalition suggests that counterfeit GLP-1 drugs have become a problem shared across political and regional lines, not an isolated issue in one state. For patients, the pressure on the FDA signals that faster federal action may be coming, though the timeline for any new rules remains unclear.
Pennsylvania Medicaid spent $69.4 million on 68,509 GLP-1 prescriptions in the first quarter of 2026, a notable decline that mirrors patterns showing up in other states this year. New Hampshire's Medicaid program saw an 88 percent drop in weight-loss drug coverage over the same period, and Puerto Rico's Medicaid program eliminated weight-loss GLP-1 coverage entirely, falling from 8,798 prescriptions to zero. Taken together, these numbers suggest that state Medicaid programs may be tightening eligibility rules or prior authorization requirements for GLP-1 drugs rather than simply seeing less demand. Pennsylvania patients currently covered through Medicaid may want to confirm their coverage status directly with their plan, since data like this often arrives before formal policy announcements do.
The throughline across these developments is that drug pricing and drug safety are both being contested right now, through federal settlements, state coalitions, and shifting Medicaid budgets. If you fill a GLP-1 prescription through Express Scripts or Caremark, check your next statement for signs of lower costs or new pricing disclosures. If you are considering a GLP-1 drug from a source outside your regular pharmacy, take the attorneys general's warnings about counterfeit 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.
Originally published on GLP1Laws.
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