Overview
- The FTC finalized a consent settlement with CVS Health’s Caremark that requires point-of-sale rebate pass-through, delinks manufacturer fees from drug list prices, gives plan sponsors an opt-out from rebate guarantees, and prohibits Caremark from blocking pharmacies that use hub services, the agency said July 14.
- The agency projects the changes could secure up to $8.5 billion in consumer savings over 10 years and unlock up to $4.5 billion in additional patient savings through counter or point-of-sale rebates.
- The FTC’s complaint alleged PBM rebate arrangements created incentives to raise list prices and prefer higher-rebate drugs, which the agency said inflated insulin prices and limited access to lower-cost options.
- For patients this means more of the rebate benefit may hit the checkout, lowering out-of-pocket costs immediately, and Caremark must count TrumpRx cash payments toward plan deductibles once federal rules and plan integration allow that treatment.
- The action follows a February settlement with Express Scripts and a paused adjudication for Optum Rx, and signals an ongoing FTC campaign under Chair Andrew Ferguson to remake how PBMs are paid and how rebates affect drug prices.