FTC Secures Landmark Settlement with CVS Caremark to Reshape PBM Business Practices and Lower Drug Costs
核心洞察
The FTC reached a settlement with CVS Caremark requiring the PBM to adopt significant business practice changes aimed at lowering patient out-of-pocket costs and increasing transparency.
The agreement locks in up to $8.5 billion in consumer savings over 10 years and unlocks up to $4.5 billion in additional savings from point-of-sale rebates.
Caremark must cease discriminating against low-cost drugs on its standard formularies and delink PBM fees from drug list prices.
The Federal Trade Commission has secured a major settlement agreement with CVS Health's Caremark Rx LLC (搜索) and Zinc Health Services LLC (搜索), resolving the Commission's antitrust case against the pharmacy benefit manager (PBM) and mandating sweeping changes to its business practices. The settlement, announced Tuesday, marks the second such resolution in the FTC's ongoing effort to rein in PBM practices that the agency alleges have artificially inflated prescription drug prices, particularly for insulin.
FTC Chairman Andrew N. Ferguson framed the settlement as a victory for American consumers. "The FTC under President Trump won't stand for anticompetitive behavior that drives up prices for American consumers," Ferguson said. "The settlement with Caremark brings billions in real savings to consumers feeling the pinch from excessive prescription drug prices."
Financial Impact and Savings Projections
The FTC estimates the settlement will lock in up to $8.5 billion in consumer savings over the next 10 years and unlock up to $4.5 billion in additional savings for patients over the same period from point-of-sale rebates. The agreement does not include monetary penalties against Caremark, and analysts have noted the settlement is not expected to eat into the PBM's profits, as the industry has already been voluntarily moving toward rebate-free models.
Key Settlement Terms
Under the terms of the proposed consent order, Caremark will be required to implement several significant changes. The PBM must cease discriminating against low wholesale acquisition cost versions of drugs on its standard formularies. It must also provide a standard offering to plan sponsors that ensures rebates are passed through to members at the point of sale, with members' out-of-pocket costs no higher than the plan sponsor's contracted rate minus any rebates, rather than the artificially inflated list price.
The settlement further requires Caremark to delink fees paid by drug manufacturers to the PBM and its Group Purchasing Organizations from list prices, increase transparency for plan sponsors, and include certain terms in its standard offering to retail community pharmacies. Caremark must also create or maintain drug affordability programs that cap members' out-of-pocket costs on insulin and provide full access to the benefits of these programs to all members when a plan sponsor adopts a formulary that includes an insulin product covered by the program.
Additionally, in the event of certain legislative and regulatory changes, Caremark must provide a standard offering that counts patient payments on TrumpRx—President Donald Trump's online drug marketplace—toward patient deductibles and out-of-pocket maximums.
Hub Pharmacy Services Provision
A notable new element in the Caremark settlement, not present in the FTC's earlier settlement with Express Scripts, addresses concerns that CVS leveraged its market power to interfere with independent pharmacies' access to hub pharmacy services. Hubs are digital platforms that streamline patients' access to medication, improve drug affordability, and support adherence by coordinating benefits and prior authorization processes, connecting patients with financial assistance, and providing drug education and care coordination.
The settlement prohibits Caremark from unfairly interfering with the ability of pharmacies in its networks to work with pharmacy hub service providers. This prohibition will be backed by a monitor empowered to receive complaints about and review actions taken against pharmacies using hub pharmacy services.
Background of the Antitrust Case
The FTC's lawsuit, originally filed in 2024 against Caremark, Express Scripts, and Optum Rx (搜索), alleged that the three PBMs—which together control approximately 80% of all prescriptions in the United States—artificially drove up the list prices of drugs by creating a system that preferences rebates. According to the complaint, this system pushed insulin manufacturers to compete for preferred formulary coverage based on the size of rebates off the list price rather than net price, ultimately benefiting the PBMs while hurting patients whose copays and coinsurance are tied to the list price.
Express Scripts settled with the FTC in February 2026 under similar terms. The Commission's case against Optum Rx (搜索) has been withdrawn from adjudication to consider a proposed consent agreement.
Industry Response
Caremark President Ed DeVaney stated, "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 noted in a statement that the settlement "eliminates the need for ongoing litigation and investigations and allows CVS Caremark to remain focused on delivering more value for American consumers and employers."
The Commission vote to accept the consent agreement for public comment was 1-0-1, with Commissioner Mark Meador recused. The public will have 30 days to submit comments on the proposed consent agreement package.