CVS unit Caremark settles FTC insulin pricing case with up to $8.5 billion in projected consumer savings
The FTC said a settlement with Caremark Rx and Zinc Health Services will separate pharmacy benefit manager fees from drug list prices and cap insulin out-of-pocket costs, resolving the agency's antitrust case against the second of three drug middlemen.
The Federal Trade Commission announced on July 14, 2026 that it had reached a settlement with Caremark Rx LLC and Zinc Health Services LLC, both part of CVS Health, resolving the agency’s antitrust case over insulin pricing. The FTC said the deal is projected to save consumers up to $8.5 billion over 10 years, with up to an additional $4.5 billion possible through point-of-sale rebates. The Commission voted 1-0-1, with Commissioner Mark Meador recused.
Under the proposed order described by the agency, the companies must delink pharmacy benefit manager fees from drug list prices, increase transparency, and give retail community pharmacies the opportunity to move to a cost-plus reimbursement model. The settlement also bars conduct that unfairly impedes the use of hub pharmacy services, with a monitor empowered to receive complaints and consider action on the hub-related provisions. Hubs, as the FTC described them, are digital platforms that coordinate benefits and prior authorizations, explain out-of-pocket options, connect patients to financial assistance, arrange delivery and provide medication education and refill reminders.
The order further requires the companies to maintain and create drug affordability programs that cap out-of-pocket costs for insulin, and to extend those program benefits to all members unless a plan sponsor declines in writing.
The underlying case alleged that Caremark, Express Scripts and Optum artificially inflated insulin list prices through their rebate practices, according to the FTC, driving competition for preferred formulary placement based on the size of rebates and increasing what patients paid out of pocket. The FTC reached a similar settlement with Express Scripts in February 2026, and the Optum matter has been withdrawn from adjudication so a proposed consent order can be considered.
Chairman Andrew Ferguson referenced administration policy achievements including TrumpRx in connection with the settlement, and the agency noted that concerns regarding CVS were raised in a House Judiciary Committee interim report dated Jan. 21, 2026. The proposed consent order is subject to a 30-day public comment period before the Commission decides whether to make it final; it carries legal force once finalized.