The Federal Trade Commission has successfully secured a settlement agreement with Caremark, the pharmacy benefit manager for CVS Health, bringing a resolution to its lawsuit against the entity. This development follows a similar settlement the FTC reached in February with Express Scripts, the PBM for Cigna. Additionally, the commission disclosed that a case against Optum has been withdrawn from adjudication to allow for consideration of a proposed consent agreement. The FTC’s legal actions against Caremark, Optum, and Express Scripts centered on allegations that the three PBMs artificially inflated the list price of insulin through anti-competitive and unfair rebating practices, which ultimately resulted in higher prices for patients. Specifically, the commission argued that the PBMs artificially drove up list prices by engineering a system that gave preference to rebates.
Under the terms of the settlement agreement, Caremark Rx and Zinc Health Services, collectively known as Caremark, have agreed to adopt changes to business practices. The FTC stated that these measures “locks in place” up to $8.5 billion in consumer savings over the next 10 years. Furthermore, the agreement unlocks up to $4.5 billion in additional savings for patients over the same decade, derived from point-of-sale rebates. Mirroring the settlement with Express Scripts, the Caremark agreement delinks PBM fees from drug list prices and enhances transparency. It also provides retail community pharmacies with the opportunity to shift to a cost-plus reimbursement model. Additionally, the settlement addresses specific concerns that Caremark interfered with patient and pharmacy access to hub pharmacy services, which serve to streamline the process of obtaining prescription drugs. Several of these concerns were previously outlined in the House Judiciary Committee’s Jan. 21, 2026, Interim Staff Report, titled “When CVS Writes the Rules: How CVS Protects Itself From Innovation and Competition,” according to the FTC.
In response to the agreement, CVS issued a statement highlighting its role in the industry. “CVS Caremark has led the industry in evolving the pharmacy benefit management model and has delivered value to our customers and clients,” said Ed DeVaney, executive vice president of CVS Health and president of CVS Caremark. “Today’s agreement advances and reinforces the changes we have already put in place and ensures affordability for families and patients across the country. CVS Caremark remains committed to lowering costs and bringing greater transparency to prescription drug pricing.” The company noted that CVS Caremark delivered nearly $900 million in savings to 25 million Americans in the past year alone. As outlined in the agreement, CVS Caremark stated it would implement a series of actions into its standard offering to commercial clients. These include aligning certain member cost sharing more closely with the net cost of medications after rebates to help push more savings to members at the point-of-sale, and simplifying pricing structures by moving away from rebate guarantees and spread pricing. The company also plans to expand transparency through enhanced reporting on drug pricing, rebates, and member payments, along with the disclosure of broker and consultant compensation. Other measures involve expanding affordability programs for medicines, including a new offering that will cap members’ insulin costs at $25 per month, and promoting point-of-sale rebate passthrough as a standard option to encourage plan sponsors to share drug cost savings more directly with members at the pharmacy counter. Furthermore, the agreement includes delinking manufacturer compensation from list prices and transitioning to acquisition-based reimbursement for independent retail pharmacies to ensure reimbursements are more closely aligned with their actual costs. It also stipulates counting TrumpRx purchases toward member deductibles and out-of-pocket maximums where allowed by law, subject to certain conditions in the settlement.
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According to the FTC complaint, the rebate system pushed insulin manufacturers, among others, to compete for preferred formulary coverage based on the size of rebates off the list price, rather than the net price. The commission alleged that this practice ultimately benefited the PBMs, which were allowed to keep some or all of the inflated rebates as well as fees paid by drug manufacturers that were based on the list price. The inflated list prices hurt patients whose out-of-pocket payments, such as copays and coinsurance, are tied to the list price of the drug, the FTC said. The public has 30 days to submit comments on the proposed consent agreement package.
“The FTC under President Trump won’t stand for anti-competitive behavior that drives up prices for American consumers,” said Chairman Andrew N. Ferguson. “The settlement with Caremark brings billions in real savings to consumers feeling the pinch from excessive prescription drug prices. And the settlement bars Caremark from interfering with hub pharmacies, which can help identify the lowest out-of-pocket option for patients and improve patient access to prescriptions.” According to data from Patients for Affordable Drugs, Caremark, Express Scripts, and OptumRx control roughly 80% of prescriptions filled in the United States. Merith Basey, CEO of Patients for Affordable Drugs, remarked on the news: “We welcome today’s settlement curbing the power of PBM giants Caremark, Express Scripts and OptumRx who control the vast majority of America’s prescriptions.”