The Federal Trade Commission (FTC) has initiated legal action against the three largest pharmacy benefit managers (PBMs)—Caremark Rx of CVS Health, Express Scripts of Cigna, and OptumRx of United Health Group—along with their associated group purchasing organizations (GPOs). The FTC claims that these entities have engaged in anticompetitive and unfair rebating practices, which have led to artificially inflated insulin prices, limited patient access to more affordable options, and increased the financial burden of high insulin costs on vulnerable patients.
The FTC's administrative complaint contends that Caremark, Express Scripts, and OptumRx, along with their respective GPOs—Zinc Health Services, Ascent Health Services, and Emisar Pharma Services—have leveraged their economic influence to manipulate the pharmaceutical supply chain, resulting in higher expenses for essential medication.
The complaint highlights that these three PBMs, known collectively as the Big Three, manage approximately 80% of all prescription medications dispensed in the United States.
It is alleged that the PBMs have established a flawed drug rebate system that incentivizes substantial rebates from drug manufacturers, subsequently inflating the list prices of insulin. According to the complaint, even when lower-priced insulin alternatives became available, potentially offering more affordable choices for vulnerable patients, the PBMs systematically excluded them in favor of more expensive, highly rebated insulin products. These practices purportedly enabled PBMs and GPOs to increase their profits while leaving many patients to cope with higher out-of-pocket expenses for insulin, the FTC asserts.