FTC v. PBMs: Express Scripts settles, Caremark fights

The FTC sued the three largest PBMs in September 2024 over rebating practices that allegedly drove up the cost of insulin.

Express Scripts settled in February. CVS Caremark filed a proposed settlement on March 23 (still pending approval, but expected to mirror the Express Scripts deal).

OptumRx is the last one fighting.

At the same time, a state audit in Tennessee found that CVS Caremark was reimbursing its own pharmacies up to 16,500% more per unit than non-affiliated pharmacies for the same drugs. The company simultaneously proposed settling federal antitrust charges and threatened to close all 134 of its Tennessee pharmacies if state PBM reform legislation passed.

And researchers at Yale and the University of Chicago published work showing hospital consolidation doesn’t just raise healthcare prices. It reduces wages and raises local unemployment — concentrated among workers earning under $100,000.

The most underused tool we have for healthcare reform is antitrust enforcement. This week we’ll talk about why that should change.

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