Caremark Rx, Zinc Health Services, Express Scripts, OptumRx

The FTC secured a settlement with Express Scripts requiring the company to adopt fundamental changes to its business practices that increase transparency. The changes are expected to drive down patients' out-of-pocket costs for drugs like insulin by up to $7 billion over 10 years and bring millions of dollars in new revenue to community pharmacies each year. The settlement advances key healthcare priorities by addressing anticompetitive practices in the pharmaceutical supply chain.

The Federal Trade Commission filed a lawsuit against the three largest prescription drug benefit managers (PBMs) - Caremark Rx, Express Scripts (ESI), and OptumRx - and their affiliated group purchasing organizations (GPOs) for engaging in anticompetitive and unfair rebating practices that have artificially inflated the list price of insulin drugs. On February 4, 2026, the FTC secured a landmark settlement with Express Scripts requiring fundamental changes to its business practices.

The PBMs engaged in anticompetitive rebating practices that artificially inflated insulin prices. The FTC alleges these companies used their market power to manipulate drug pricing through complex rebate arrangements that increased costs for consumers while benefiting the PBMs. These practices involved unfair methods of competition that harmed consumers by keeping insulin prices artificially high despite available lower-cost alternatives.