The Federal Trade Commission may be winding down its ongoing insulin case against the three largest pharmacy benefit managers, as court documents suggest the agency has reached an agreement with Optum Rx.
In court documents released (PDF) on Friday, the commission and Optum have jointly agreed to withdraw the case as they pursue a settlement. Additional details on what that settlement may include have not yet been released.
If a consent agreement is reached, it would "resolve the claims against the Optum respondents in their entirety," according to the filing. In the initial case, the FTC alleged that Optum and the other two members of the PBM industry's "Big Three"—CVS Health's Caremark and the Cigna Group's Express Scripts—engaged in anticompetitive activities that drove up the price of insulin.
The lawsuit was filed in September 2024, and followed a lengthy FTC probe into major PBMs' business practices.
"OptumRx has long worked to make insulin easier to afford and access for our health plan customers and their members, who now pay on average $12 per month for insulin," a spokesperson for Optum told Fierce Healthcare. "We continue to engage constructively with the FTC and remain focused on removing barriers to care and helping people get the medications they need."
Optum was the final holdout of the three companies in reaching a settlement, though the FTC said in early March that the discussions were seeing progress. Express Scripts was the first to reach a settlement with the agency in February, and the deal includes multiple agreements from the PBM to adjust its business practices.
Under the settlement, Express Scripts agreed to roll out a standard formulary offering in which the out-of-pocket expenses for patients are based on a drug's net cost, rather than the list price. It also agreed on reshore Ascent, its group purchasing organization, moving the unit to the United States from Switzerland.
Caremark's agreement with the FTC, which was reached in late March, is in line with the settlement reached with Express Scripts, sources told Reuters in March.
As drug prices rise, PBMs have been in the spotlight for both regulators like the FTC and lawmakers on the Hill.
Earlier this year, legislators passed major reforms for the industry as part of a broader appropriations deal. Under that law, pharmacy benefit managers are required to pass through rebates to the payer, or face potential fines from the Centers for Medicare & Medicaid Services.
The law also requires that PBM fees be "delinked" from the list price of drugs in Medicare Part D.