FTC settles insulin-pricing case with CVS Caremark
The Federal Trade Commission settled its lawsuit against CVS Caremark, the pharmacy benefit manager the agency had accused of building a rebate system that favored high-list-price insulin at patients’ expense. The original case, brought against the three largest PBMs — CVS Caremark, Cigna’s Express Scripts and UnitedHealth’s Optum Rx — alleged the companies steered plans toward insulins with inflated list prices to capture larger rebates.
Under the deal, CVS Caremark must change how it deals with employers, health plans and pharmacies. The FTC estimates the terms could produce up to $8.5 billion in out-of-pocket savings over 10 years, plus up to $4.5 billion more through rebates paid at the pharmacy counter.
The settlement resolves the case against only one of the three named PBMs, leaving the broader industry practice largely intact unless Express Scripts and Optum Rx reach similar terms. It is a targeted concession rather than a structural change to how rebates drive insulin pricing.