The Federal Trade Commission reached a settlement with CVS Caremark that requires the pharmacy benefit manager to change its business practices as part of the agency’s antitrust case alleging the PBM inflated insulin list prices through rebate practices.
The FTC said the settlement will secure up to $8.5 billion in consumer savings over the next 10 years and unlock up to $4.5 billion in additional patient savings through point-of-sale rebates over the same period, according to a July 14 FTC news release.
Under the settlement, CVS Caremark must pass rebates through to patients at the point of sale, delink manufacturer fees from drug list prices, increase transparency for health plans and give plan sponsors options to move away from rebate guarantees and spread pricing. The agreement also prohibits Caremark from interfering with pharmacies that work with hub service providers intended to improve medication access and affordability.
The case dates back to September 2024, when the FTC sued Caremark, Express Scripts and Optum Rx, accusing the three PBMs of excluding low-cost insulins from formularies to secure higher rebates. The PBMs pushed back, and litigation stalled in April 2025 when the case was paused due to a lack of participating commissioners, before FTC Chair Andrew Ferguson ended his recusal and cleared the way for proceedings to resume.
The FTC reached a similar settlement with Express Scripts in February, requiring the PBM to pass through rebates at the point of sale, allow plan sponsors move away from rebate guarantees and pay community pharmacies based on drugs’ actual costs, while offering access to TrumpRx. The FTC’s case against Optum has been withdrawn from adjudication as the agency considers a consent agreement.
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