The Federal Trade Commission announced on July 14, 2026, that Caremark Rx LLC and Zinc Health Services LLC, collectively known as Caremark, agreed to a proposed settlement resolving the Commission’s antitrust case against the pharmacy benefit manager and its affiliated entities. The agreement would require changes intended to reduce patients’ out-of-pocket costs, increase transparency and ensure that retail community pharmacies are treated fairly.

The FTC said the settlement could lock in up to $8.5 billion in consumer savings over the next 10 years and unlock up to $4.5 billion in additional patient savings over the same period through point-of-sale rebates. Like the Commission’s February 2026 settlement with Express Scripts Inc., the Caremark agreement would delink PBM fees from drug list prices and give retail community pharmacies an opportunity to move to a cost-plus reimbursement model.

The FTC under President Trump won’t stand for anticompetitive behavior that drives up prices for American consumers,

Chairman Andrew N. Ferguson said. The FTC’s lawsuit alleged that Caremark, Express Scripts and Optum artificially inflated insulin list prices through anticompetitive and unfair rebating practices. According to the complaint, the system favored rebates based on list prices rather than net prices, while some patients’ copayments and coinsurance were tied to the inflated list prices.

Proposed requirements

Under the proposed consent order, Caremark would be required to adopt standard offerings for plan sponsors that pass rebates through to members at the point of sale and ensure that members’ out-of-pocket costs are no higher than the plan sponsor’s contracted rate minus rebates. The order would also require Caremark to provide options allowing plan sponsors to move away from rebate guarantees and spread pricing, delink manufacturer fees from list prices, increase transparency and include specified terms for retail community pharmacies.

  • Cease discriminating against low wholesale acquisition cost versions of a drug on standard formularies
  • Create or maintain insulin affordability programs that cap members’ out-of-pocket costs, unless a plan sponsor opts out in writing
  • Allow, under specified legislative and regulatory changes, certain TrumpRx payments to count toward deductibles and out-of-pocket maximums
  • Maintain its respective group purchasing organization activities in the United States

The proposed order would also prohibit Caremark from unfairly interfering with network pharmacies’ ability to work with pharmacy hub service providers. A monitor would be empowered to receive complaints and review actions involving pharmacies that use hub services. The FTC described hubs as digital platforms that may coordinate benefits and prior authorization, identify out-of-pocket options, connect eligible patients with financial assistance, deliver medicines and provide education, care coordination and refill reminders.

The settlement resolves the FTC’s case against Caremark. The Commission’s case against Optum has been withdrawn from adjudication to consider a proposed consent agreement. The Commission voted 1-0-1 to accept the Caremark consent agreement for public comment, with Commissioner Meador recused. The public will have 30 days to submit comments. If issued on a final basis, a consent order carries the force of law with respect to future actions.