Health Law Daily Wrap Up, PRESCRIPTION DRUGS—SETTLEMENT AGREEMENTS: FTC touts Caremark settlement will drive down patient costs, increase transparency, benefit community pharmacies, (Jul 16, 2026)

By Justin Marcus Smith, J.D.

The FTC is touting lock-in of $8.5 billion in consumer savings involving, among other measures, caps on insulin out-of-pocket costs.

The FTC announced a settlement agreement with Caremark Rx LLC and Zinc Health Services LLC (collectively, Caremark). Caremark did not admit or deny any FTC allegations. The FTC secretary withdrew the FTC administrative complaint thereby resolving the case against Caremark, one of the largest pharmacy benefit managers (PBMs), also a subsidiary of CVS Health Corp. The FTC announced a similar settlement with Express Scripts, Inc. (ESI) in February. The FTC reiterated earlier statements that its settlement agreement requires Caremark to adopt changes to its business practices to “drive down patients’ out-of-pocket costs, increase transparency and ensure community pharmacies are treated fairly.” According to the FTC, the proposed settlement package, in the form of a decision and order and agreement containing consent order, “locks in place up to $8.5 billion in consumer savings over the next 10 years and unlocks up to $4.5 billion in additional savings for patients over the same 10-year period from point-of-sale rebates. Specific terms address insulin price caps and concerns that Caremark interfered with patient and pharmacy access to so-called hub pharmacy services that facilitate patient access to drugs. FTC Chair Andrew N. Ferguson said the settlement shows that President Trump’s FTC “won’t stand” for anticompetitive behavior. The Commission vote to accept the consent agreement for public comment was 1-0-1, with Commissioner Meador recused. The public will have 30 days to submit comments on the proposed consent agreement package pursuant to instructions to be posted on Regulations.gov (In the Matter of Caremark Rx, LLC, FTC Docket No. 9437, Jul 14, 2026).

Background. In September 2024, the FTC brought an administrative complaint against the three largest PBMS, i.e., Caremark, ESI, and Optum entities OptumRx, Inc. and OptumRx Holdings, LLC, as well as their respective affiliated group purchasing organizations (GPOs). The complaint alleged that the Caremark respondents engaged in anticompetitive and unfair rebating practices that artificially inflated the list price of insulin drugs; impaired patients’ access to lower list price products; and shifted the cost of high insulin list prices to vulnerable patients. The complaint further alleged that PBMs keep hundreds of millions of dollars in rebates and fees each year and use rebates to attract clients

As the FTC announced in February 2026, ESI already agreed to a number of changes to its business practices.

The FTC published an analysis of the instant agreement with Caremark to aid public comment. In that analysis, the FTC said that purpose of the consent agreement is to protect the public from alleged Caremark anticompetitive conduct and to deter such future conduct.

General requirements. Subject to public comment, the proposed consent order contained in the executed consent agreement will require Caremark to:

1. stop discriminating against low wholesale acquisition cost (WAC2) versions of a drug on its standard formularies;

2. provide a standard offering to its plan sponsors that ensures that members will get the benefits of their share of rebates at the point of sale;

3. in the event of certain legislative and regulatory changes, provide a standard offering to its plan sponsors that counts patient payments on TrumpRx toward patient deductibles and out-of-pocket maximums, for covered drugs and drugs with most favored nation (MFN) pricing;

4. create a Copay Certainty Program that caps members’ out-of- pocket costs on insulin, as further described below;

5. provide a standard offering to all plan sponsors that allows the plan sponsor to transition off rebate guarantees and spread pricing;

6. delink, for its standard offering, drug manufacturers’ compensation to Caremark from list prices;

7. increase transparency for plan sponsors;

8. include certain terms in its standard offering to retail community pharmacies;

9. allow pharmacies in its networks to work with pharmacy hub service providers;

10. promote the standard offerings to plan sponsors and retail community pharmacies; and,

11. maintain its Zinc GPO activities in the United States.

Insulin. As mentioned above, the agreement includes terms intended to cap insulin prices. No later than January 1, 2028, when a plan sponsor adopts a formulary including an insulin product covered by the Copay Certainty Program, Caremark shall provide full access to the program including at least one participating insulin product, as defined, in each of the “rapid-acting, short-acting, and long-acting insulin categories” to all buying members, unless the plan sponsor opts-out in writing.

According to the FTC decision and order, this will ensure member out-of-pocket costs for participating insulin will be capped at no greater than $25 for a prescription claim for under 34 days’ supply; $50 for a prescription claim with 35-68 days’ supply; and $75 for 69 or longer days’ supply.

Community pharmacies. The agreement provides that Caremark will compensate each retail community pharmacy, as defined, based on its actual cost of acquiring prescription drugs, plus a dispensing fee. However, that is contingent on the retail community pharmacy providing necessary data to validate its acquisition cost. Caremark will also make additional payments for all non-dispensing services performed by retail community pharmacies and not exclude any that are willing to agree to the terms and conditions of the Caremark standard offering to such pharmacies.

Hub access. The consent order proposed for public comment will also prohibit Caremark from “unfairly interfering with the ability of pharmacies in its networks to work with pharmacy hub service providers.” Hubs are digital platform that aim to streamline patient access to medication by various means, like coordinating the prior authorization process. The agreement will empower a monitor to hear complaints about actions taken against pharmacies using hub pharmacy services.

Companies: Caremark Rx LLC and Zinc Health Services LLC

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