CVS Health’s Caremark has reached a settlement with the federal government in a lawsuit over insulin pricing, the latest of the “Big Three” prescription drug middlemen to strike such a deal.
According to the filing, the proposed deal would “resolve all of the claims against the Caremark Respondents.” It has already been approved by CVS, FTC attorneys, and the agency’s competition and consumer protection bureaus, but still requires signoff from FTC leadership, including Chairman Andrew Ferguson.
A CVS spokesperson said the company expects the settlement process to be completed within the next few weeks. Final terms are still pending and will be disclosed once the agreement is formally finalized.
Details of the proposal have not yet been made public, but it’s expected to be similar to the agreement the FTC reached last month with Cigna’s Express Scripts.
If approved, the CVS deal would leave UnitedHealth’s Optum Rx as the only remaining defendant in the high-profile insulin pricing case.
The FTC sued Caremark, Express Scripts, and Optum Rx—the nation’s three largest prescription drug benefit managers—in September 2024, accusing them of inflating insulin costs through anticompetitive and unfair rebate negotiations with drug manufacturers.
All three companies denied the allegations. Still, Express Scripts agreed to settle with the government and make several business changes aimed at lowering insulin costs.
Under that agreement, Express Scripts’ standard plan offerings to employers will no longer favor drugs with high wholesale acquisition costs when lower-cost alternatives are available. Any fees it receives from drugmakers will also be “delinked” from the list prices of medications.
The FTC said the deal could cut patients’ out-of-pocket costs for drugs such as insulin by as much as $7 billion over the next decade. It also said the agreement could generate millions of dollars in additional revenue for community pharmacies by requiring Express Scripts to adopt a cost-plus reimbursement model.
In addition, Express Scripts agreed to move its group purchasing organization, Ascent, from Switzerland back to the United States—a step the FTC said would return more than $750 billion in purchasing activity over the duration of the order.
Express Scripts further agreed to count purchases made through the direct-to-consumer TrumpRx platform toward a patient’s deductible and out-of-pocket maximum, “once necessary legal and regulatory groundwork is laid,” according to the FTC.
As of March, the platform offered what the administration called “most-favored-nation” pricing on 57 drugs, including insulin, with some brand-name medications discounted by 50 percent or more.
