WASHINGTON, D.C. — CVS Health’s Caremark pharmacy benefit manager agreed to change how it prices and administers prescription-drug benefits under a proposed Federal Trade Commission settlement that the agency estimates could generate as much as $13 billion in patient savings over 10 years.
The agreement would resolve the FTC’s case accusing Caremark of using rebate practices that favored higher-priced insulin products and increased costs for patients whose copayments and coinsurance were tied to list prices.
Caremark Rx LLC and affiliated purchasing organization Zinc Health Services LLC must offer plan sponsors options that pass drug rebates to members at the pharmacy counter, separate certain fees from drug list prices and allow plans to move away from rebate guarantees and spread pricing.
The FTC estimates the order would preserve as much as $8.5 billion in consumer savings and create up to $4.5 billion in additional savings through point-of-sale rebates during the next decade. Those figures are agency projections rather than guaranteed savings.
Caremark must also stop discriminating against lower wholesale acquisition cost versions of drugs on its standard formularies. The restriction targets a rebate system that the FTC alleges encouraged manufacturers to compete for preferred coverage by offering larger discounts from inflated list prices instead of lowering net prices.
The proposed order would require Caremark to offer plan sponsors terms ensuring that members pay no more than the contracted price after applicable rebates, rather than an amount calculated from the drug’s list price.
Caremark would also have to increase pricing disclosures to plan sponsors and offer retail community pharmacies an opportunity to transition to a cost-plus reimbursement model.
The company must maintain or establish programs capping members’ out-of-pocket insulin costs. Members would receive full access to those programs when their employer or health plan adopts a participating formulary unless the plan sponsor opts out in writing.
“The settlement with Caremark brings billions in real savings to consumers feeling the pinch from excessive prescription drug prices,” FTC Chairman Andrew Ferguson stated.
The order would also restrict Caremark from interfering with pharmacies that use hub service providers. Those digital platforms can coordinate insurance approvals, identify financial assistance, explain patient costs and arrange medication delivery.
An independent monitor would be authorized to receive complaints and review Caremark’s treatment of pharmacies using hub services.
The provisions address FTC concerns that Caremark limited pharmacy and patient access to those platforms. A January 2026 House Judiciary Committee staff report also examined allegations that CVS used its market position to restrict competing pharmacy services.
Caremark is a subsidiary of CVS Health Corp., which owns health insurer Aetna and one of the nation’s largest retail pharmacy networks. The FTC’s case focused on whether vertically integrated benefit managers used formulary and rebate systems to favor higher drug prices while shifting costs to certain patients.
The agency brought the case against Caremark, Express Scripts Inc. and Optum, alleging that the three pharmacy benefit managers created incentives that inflated insulin list prices while generating rebate and fee revenue.
The FTC reached a similar agreement with Express Scripts in February 2026. Its case against Optum has been removed from administrative adjudication while the commission considers a proposed consent agreement.
Caremark’s order contains a conditional provision requiring it to offer plans a way to count qualifying purchases through TrumpRx toward patient deductibles and out-of-pocket limits if specified legislative or regulatory changes occur.
Caremark and Zinc would also be required to keep their group purchasing organization operations in the United States.
The commission voted 1-0-1 to accept the proposed agreement for public comment, with Commissioner Mark Meador recused. The order is not final and may be modified after the 30-day comment period.
Instructions for submitting comments are available at https://www.federalregister.gov/documents/2026/02/12/2026-02844/express-scripts-inc-et-al-analysis-of-agreement-containing-consent-order-to-aid-public-comment.
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