Dive Brief:
- Major pharmacy benefit managers’ countersuit against the Federal Trade Commission for accusing them of inflating the cost of insulin has been dismissed, after Express Scripts, Caremark and Optum Rx elected to settle with antitrust regulators over the allegations.
- The 8th Circuit Court of Appeals dismissed the lawsuit on Tuesday after both sides mutually decided to drop the litigation. Cigna’s Express Scripts, CVS’ Caremark and UnitedHealth’s Optum Rx had turned to the 8th Circuit in early 2025 after a district court declined to halt the FTC’s insulin pricing lawsuit against them.
- Express Scripts formally settled with the FTC over the allegations in February, while Caremark and Optum Rx agreed to proposed settlements in March and June, respectively.
Dive Insight:
The FTC sued Express Scripts, Caremark and Optum Rx in late 2024, arguing that the drug middlemen prefer more expensive insulin products because they result in higher rebates from pharmaceutical companies. Pharmaceutical companies are incentivized to hike prices for insulin as a result, antitrust regulators said.
The PBMs — which hold oligopolistic control over the U.S. drug market, jointly controlling 80% of all the country’s prescriptions — vehemently denied the allegations, and quickly countersued.
But in February 2025 the district court ruled the FTC’s case could move forward, sending the PBMs hustling to the 8th Circuit to plead for an injunction halting the suit.
The 8th Circuit denied the PBMs’ request last March. And now, the appeals court is dismissing the countersuit altogether, one day after the parties filed a joint stipulation asking the court to end the case — a mechanism typically used when the opposing sides have reached a settlement.
Express Scripts is the only company to have inked an official settlement. The deal is largely viewed as positive for the PBM, while addressing some of the FTC’s key concerns with the company’s business practices. It requires Express Scripts to delink its compensation from the savings it negotiates with drugmakers, stop preferring expensive drugs over cheaper equivalents on standard formularies and increase transparency around drug spending, among other actions.
The deal should drive down patients’ out-of-pocket costs for drugs like insulin by up to $7 billion over a decade, the FTC said. But it likely does so without affecting Express Script’s bottom line, given the PBM was already pursuing many of the reforms on its own.
Details are not yet public on the proposed deals offered by Optum Rx and Caremark, though experts believe they’ll be similar to Express Scripts’ agreement.
