The 8th Circuit Court of Appeals dismissed a countersuit filed by three major pharmacy benefit managers against the Federal Trade Commission, ending a legal battle over insulin pricing that began in late 2024. The case followed the FTC’s allegations that the companies drove up the cost of insulin. The dismissal came after Express Scripts, Caremark and Optum Rx elected to settle with antitrust regulators over the allegations. The 8th Circuit Court of Appeals dismissed the lawsuit on Tuesday after both sides mutually decided to drop the litigation.
The lawsuit, brought by the PBMs in response to the FTC’s allegations, was dropped after the companies reached separate agreements with the commission. The court’s decision came one day after both sides filed a joint stipulation to dismiss the case. Express Scripts formally settled with the FTC over the allegations in February, while Caremark and Optum Rx agreed to proposed settlements in March and June, respectively.
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The FTC had accused the PBMs of driving up insulin costs by favoring higher-priced drugs that generated larger rebates from pharmaceutical manufacturers. According to the agency, this practice created an incentive for drugmakers to inflate list prices. The PBMs, which hold oligopolistic control over the U.S. drug market, jointly controlling 80% of all the country’s prescriptions, vehemently denied the allegations.
In early 2025, Cigna’s Express Scripts, CVS’ Caremark and UnitedHealth’s Optum Rx had turned to the 8th Circuit after a district court declined to halt the FTC’s insulin pricing lawsuit against them. The formal dismissal of the countersuit this week marked the final resolution of the legal dispute.
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The three PBMs control roughly 80% of the U.S. prescription market, a concentration of influence that has drawn scrutiny from policymakers and consumer advocates. The FTC’s case centered on the argument that the PBMs’ business practices had led to higher prices for essential medications like insulin, which has seen dramatic cost increases over the past two decades despite being a century-old drug. The settlements do not include formal admissions of guilt.
The legal battle may be over, but the FTC’s focus on PBMs shows no signs of slowing. The agency has indicated that it will continue to investigate the industry’s practices. The settlements with Express Scripts, Caremark, and Optum Rx could serve as a template for future enforcement efforts. Meanwhile, the industry is likely to push back against further regulation.
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For now, the immediate legal dispute has concluded, but the broader debate over drug pricing and the role of PBMs continues.
