The Federal Trade Commission may be closing its ongoing insulin case against the three largest pharmacy benefit managers, as court documents suggest the agency has reached a settlement with Optum Rx.
In court documents released (PDF) On Friday, the commission and Optum jointly agreed to drop the case while they seek a settlement. Additional details on what that deal might include have not yet been released.
If a consent agreement is reached, it would “resolve the claims against the Optum Defendants in their entirety,” according to the filing. In the initial case, the FTC alleged that Optum and the other two members of the PBM industry’s “Big Three” (CVS Health’s Caremark and Cigna Group’s Express Scripts) engaged in anticompetitive activities that raised the price of insulin.
The lawsuit was filed in September 2024 and followed a lengthy FTC investigation into the business practices of major PBMs.
“OptumRx has long worked to make insulin more affordable and accessible for our health plan customers and their members, who now pay an average of $12 per month for insulin,” an Optum spokesperson told Fierce Healthcare. “We continue to engage constructively with the FTC and remain focused on removing barriers to care and helping people get the medications they need.”
Optum was the last hurdle between the three companies in reaching a deal, although the FTC said in early March that talks were moving forward. Express Scripts was the first to reach an agreement with the agency in February, and the agreement includes multiple PBM agreements to adjust its business practices.
Under the agreement, Express Scripts agreed to implement a standard formulary offering in which patients’ out-of-pocket costs are based on the net cost of a drug, rather than the list price. It also agreed to relocate Ascent, its group purchasing organization, moving the unit to the United States from Switzerland.
Caremark’s settlement with the FTC, which was reached in late March, is in line with the agreement reached with Express Scripts, sources told Reuters in March.
As drug prices rise, PBMs have been in the spotlight for both regulators like the FTC and lawmakers on Capitol Hill.
Earlier this year, lawmakers approved major reforms for the industry as part of a broader appropriations deal. Under that law, pharmacy benefit managers must pass on reimbursements to the payer or face potential fines from the Centers for Medicare and Medicaid Services.
The law also requires that PBM fees be “decoupled” from the list price of drugs in Medicare Part D.
