The Federal Trade Commission said Caremark Rx and Zinc Health Services agreed to a proposed settlement requiring changes to pharmacy benefit manager practices tied to insulin rebates, pharmacy hubs and patient drug costs.
What happened
The Federal Trade Commission announced Tuesday that Caremark Rx LLC and Zinc Health Services LLC agreed to a proposed settlement resolving the agency's antitrust case against the pharmacy benefit manager over alleged insulin-pricing practices.
The proposed deal would require Caremark to change business practices the agency says affect patient out-of-pocket costs, plan-sponsor transparency and community pharmacy treatment. The FTC says the settlement would lock in up to $8.5 billion in consumer savings over 10 years and unlock up to $4.5 billion in additional patient savings over the same period from point-of-sale rebates.
The FTC said its case alleged that Caremark, Express Scripts and Optum artificially drove up drug list prices through a rebate-preferencing system that pushed insulin manufacturers to compete for preferred formulary coverage based on rebate size rather than net price. The agency alleged that patients whose copays and coinsurance were tied to list prices were hurt by inflated insulin list prices.
Under the proposed order, Caremark would have to stop discriminating against low-wholesale-acquisition-cost drug versions on its standard formularies, offer point-of-sale rebate pass-throughs and delink certain manufacturer-paid PBM and group purchasing organization fees from list prices. The proposed terms also include standard offerings for plan sponsors to move away from rebate guarantees and spread pricing and to increase transparency.
The order also would require insulin affordability programs in some circumstances and would bar Caremark from unfairly interfering with network pharmacies' work with hub pharmacy service providers, backed by a monitor. The FTC described hubs as digital platforms that can help patients navigate benefits, prior authorization, cost options, financial assistance, delivery, education and refills.
The Commission voted 1-0-1 to accept the consent agreement for public comment, with Commissioner Mark Meador recused, and the public will have 30 days to submit comments. The agency said it reached a similar settlement with Express Scripts in February 2026 and that its case against Optum has been withdrawn from adjudication while the Commission considers a proposed consent agreement.