PBMs and FTC Battle in Court Over In-House Insulin Pricing Challenge Intensifies

The Federal Trade Commission (FTC) filed a major lawsuit in September 2024 against the three largest pharmacy benefit managers (PBMs)—CVS Caremark, Express Scripts, and OptumRx—alleging anticompetitive rebate schemes that inflated insulin prices, restricted access to lower-priced products, and shifted high costs to vulnerable patients3 4 5 8 11.

The FTC claims PBMs created a system prioritizing high-rebate, high-list-price insulin drugs, purposely excluding lower-priced alternatives and thus increasing costs for patients who need insulin to survive3 5 8.

The FTC's case is proceeding through its in-house administrative process, but PBMs are fighting back in court, seeking to dismiss or halt these proceedings on grounds that the agency is exceeding its authority and that drug manufacturers ultimately set the list prices1 7 10 18.

At different stages, the lawsuit was paused due to recusals and vacancies among FTC commissioners, but resumed once conflicts were resolved in early 20252 13.

PBMs have also countersued the FTC, arguing the agency's administrative process is unconstitutional and biased, aiming to block FTC jurisdiction and stop the in-house proceedings16 18.

Senators and advocacy groups have welcomed the FTC's actions, emphasizing the urgent need for price relief for insulin-dependent patients and calling for greater transparency and legislative reforms4 8.