The FTC’s Pharmacy Benefit Manager Settlements Could Rewrite Contracts Before Congress Does

The Federal Trade Commission did not obtain a trial judgment against the nation’s largest pharmacy benefit managers. It may still have written the first serious federal template for changing how they pay pharmacies and structure drug rebates.

The agency accused Caremark, Express Scripts, and OptumRx, together with affiliated group purchasing organizations, of using rebate-driven formulary practices that favored high-list-price insulin products and impaired access to lower-price versions. The complaint remains an allegation, not a judicial finding.¹

Express Scripts reached a proposed settlement in February 2026. Caremark followed in July. The Commission withdrew its proceeding against OptumRx while it considers a proposed agreement.²

The pharmacy provisions deserve close attention

The Caremark order would require a standard offering for qualifying retail community pharmacies, based on the actual drug acquisition cost plus a dispensing fee. It also requires additional payment for covered pharmacist services that do not involve dispensing and prohibits the exclusion of a qualifying pharmacy willing to accept the offering.³

The order also limits interference with pharmacy hub-service arrangements. A monitor could receive complaints and review actions involving pharmacies that use those services.⁴

The plan-sponsor provisions reach the rebate machinery. The standard offering would prohibit spread pricing, move member cost sharing away from inflated list prices, permit point-of-sale rebate treatment, and delink manufacturer compensation from list price.⁵

The limits are as important as the promises

These orders do not create a statute governing every company, pharmacy, or benefit plan. The Caremark proposal defines a retail community pharmacy as an unaffiliated business with three or fewer locations. It also confines several protections to a standard commercial offering and excludes Medicare, Medicaid, and exchange plans from key definitions.⁶

Caremark also did not admit the alleged violation or the complaint’s non-jurisdictional facts.⁷

Still, the orders can influence conduct beyond their formal reach. Plan sponsors can demand comparable terms. State lawmakers can use the provisions as drafting models. Pharmacies can use the required offerings as benchmarks when evaluating network contracts. Future plaintiffs may point to the Commission’s remedies when arguing that less restrictive commercial structures were feasible.

The Commission settled the cases. It did not settle the larger fight. It gave that fight a working blueprint.

For the procedural and precedential limits of the proposed orders, read Two PBM Settlements, No Precedent. You can also review areas of experience or see the author’s background.

This article provides general information and does not constitute legal advice. It relies solely on public sources. Reading it does not create an attorney-client relationship.