The Federal Trade Commission may be close to concluding its legal action against the nation's three largest pharmacy benefit managers over insulin pricing. UnitedHealth's Optum Rx has reached a tentative settlement with the FTC, joining CVS Health's Caremark and the Cigna Group's Express Scripts, which agreed to settlements earlier this year.
The proposed consent agreement has been approved by directors of the FTC's bureaus of competition and consumer protection, although details of the agreement have not been disclosed.
The FTC alleged in a lawsuit filed during the Biden administration in the fall of 2024 that the three PBMs engaged in anticompetitive activities that drove up the price of insulin, such as steering patients toward higher-cost medications to collect larger rebates from drug manufacturers.
"The PBMs have created and managed a system in which drug manufacturers compete for formulary placement by raising (not lowering) drug list prices so they can feed the higher rebates that PBMs demand," Rahul Rao, deputy director of the FTC Bureau of Competition, said in a statement at the time. "This perverse system results in billions of dollars in rebates and fees for the PBMs and their health plan sponsor clients -- but does so at the expense of certain vulnerable diabetic patients, who must pay significantly more out-of-pocket for their critical medications."
The FTC and Optum Rx have jointly agreed to withdraw the case as they pursue a settlement, according to court documents.
"OptumRx has long worked to make insulin easier to afford and access for our health plan customers and their members, who now pay on average $12 per month for insulin," an Optum Rx 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."
Although all three PBMs have denied the agency's allegations, each has moved toward a settlement with the FTC this year. Express Scripts reached a deal in early February that requires it to delink its compensation from the savings it negotiates with pharmaceutical companies. It also must stop preferring medications with high list prices, among other requirements. The company also will move Ascent, its group purchasing organization, back to the United States from Switzerland as part of the agreement. Caremark reached a proposed settlement with the FTC in late March, although it has not yet been finalized.
The FTC will review the proposed consent agreement with Optum Rx and, if approved, the case will be dismissed. If not, litigation could continue, but the progress so far suggests the agency is likely to close the case against Optum Rx soon, according to Yahoo Finance.
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