FTC Sues Major Pharmacy Benefit Managers Over Insulin Prices

The agency’s complaint filed Friday alleges Caremark, Express Scripts and Optum Rx steered patients toward higher priced insulin to bring in larger rebates from pharmaceutical manufacturers.

WASHINGTON — The Federal Trade Commission is suing Express Scripts, Caremark and Optum Rx, the three largest pharmacy benefit managers in the U.S., over their alleged role in inflating the cost of insulin.

This move comes after a lawsuit filed in federal court in Missouri by Express Scripts by Evernorth, a subsidiary of the Cigna Group, demanded that the FTC retract its July 2024 report, which it says is filled with false and misleading claims about the PBM industry and fails to serve the interests of American consumers.

The agency’s complaint filed Friday alleges CVS’ Caremark, Cigna’s Express Scripts and UnitedHealth’s Optum Rx steered patients toward higher-priced insulin to bring in larger rebates from pharmaceutical manufacturers.

As a result, the list price of insulin rose and patients who weren’t eligible for discounted drugs faced higher costs, while the PBMs raked in billions of dollars in rebates, the FTC ­alleges.

The long-awaited lawsuit comes amid rising tensions between the drug supply chain middlemen and lawmakers and regulators looking to crack down on sky-high U.S. drug prices.

In a statement, Rahul Rao, the deputy director of the FTC’s Bureau of Competition, called Caremark, Express Scripts and Optum Rx “medication gatekeepers” that “extracted millions of dollars off the backs of patients who need life-saving medications.”

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