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ARTICLE · 20 JULY 2026

FTC Reaches Second Insulin Pricing Settlement: Comparing The Caremark And ESI Orders

Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.
Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.
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Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

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The Federal Trade Commission has reached a settlement with Caremark, one of the nation's largest pharmacy benefit managers, following allegations that rebate-driven formulary practices artificially inflated insulin prices and increased patient costs. This Decision and Order imposes sweeping reforms to PBM business practices, including requirements for low-cost drug alternatives, enhanced transparency measures, and new protections for independent pharmacies. How does this settlement compare to the earlier ES

United StatesConsumer Protection
Rachel A. Alexander
Rachel A. Alexander
Theresa Carnegie
Theresa Carnegie
Hassan Shaikh
Hassan Shaikh
Grace Callander
Grace Callander
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On July 14, 2026, the Federal Trade Commission (FTC) announced its settlement with Caremark Rx, LLC and Zinc Health Services, LLC (Caremark) to resolve claims from the FTC’s 2024 Complaint alleging Caremark, OptumRx, Inc. (OptumRx), and Express Scripts, Inc (ESI) used anticompetitive rebate schemes to artificially inflate insulin prices.

Background 

The 2024 Complaint alleged that the above-named pharmacy benefit managers (PBMs) engaged in unfair methods of competition and unfair acts or practices in violation of the FTC Act. Specifically, the Complaint alleged that the PBMs used rebate-driven formulary practices that encouraged manufacturers to compete for formulary placement based on rebate size rather than the net cost of insulin. According to the FTC, this structure resulted in higher insulin list prices and increased out-of-pocket costs for patients.

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