FTC settles lawsuit with Optum Rx, ending its campaign against the ‘big three’ PBMs
The Federal Trade Commission's (FTC) lawsuit against the “big three” pharmacy benefit manager (PBM) companies may nearly be over, as the agency has settled the case by getting concessions from each defendant.
In an updated filing withdrawing its adjudication, the FTC said it reached a settlement with UnitedHealth Group, the parent company of Optum Rx, that would “resolve the claims against the Optum Respondents in their entirety.”
The agency had formally accused Optum Rx, along with its integrated group purchasing organization, of violating federal antitrust law by artificially inflating the price of insulin. The other PBM defendants were accused of the same thing; a scheme the agency said involves the use of drug manufacturer rebates that are ultimately not passed down to group plans and pharmacies.
Now, that entire lawsuit has fizzled into a series of settlements, as both Cigna’s Express Scripts and CVS’ Caremark reached agreements with the agency earlier this year that halted antitrust proceedings.
Notably, the terms of the agreement with Optum Rx will still need to be approved by agency leadership. For now, it’s not clear what specific changes to its business practices the PBM will need to make to appease regulators, though those details should be made public once the FTC makes a formal announcement.
Whatever the terms are, there were enough to make some at the FTC happy. Per the withdrawal filing, the agency’s bureaus of competition and consumer protection have already signed off on the settlement, assuming Optum Rx complies with the consent agreement.
In its settlement with regulators, Express Scripts agreed to stop favoring pricier insulin when making purchasing decisions for health plans, while also passing down rebates from drug suppliers to ensure patients get the cheapest price available.
CVS’ Caremark made similar concessions, with the FTC promising that the deals would reduce the price of insulin significantly over time.
‘Strengthening transparency’
An announcement Optum Rx made last month could hold clues as to the agreement it made with the FTC. In it, the company promised to be open about the cost of drugs as they travel through the supply chain, so that its customers can understand the price they’re paying.
Further, the PBM said it would be moving away from rebate-based pricing arrangements, ostensibly avoiding rebates, in favor of a supply-and-demand-based fee model. To that end, Optum Rx said it was “committed to passing through 100% of manufacturer drug rebate discounts to clients by Jan. 1, 2028.”
Whether or not this is all enough to appease the FTC remains to be seen.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.