FTC settlement with Caremark aims to cap insulin copays and boost pharmacy transparency—what’s next
The FTC says a proposed consent order with Caremark and Zinc would cap insulin copays and add pricing transparency—public comments come first.
On July 14, 2026, the Federal Trade Commission said it accepted a proposed settlement that would change how Caremark (and Zinc Health Services) administer insulin pricing, rebates, and pharmacy access.
For patients and community pharmacies, the timing matters: this is not final yet. The FTC is asking the public to comment first before the Commission moves toward a final consent order.
What the FTC case was about (in plain terms)
The FTC describes the dispute as targeting PBM practices that, in the agency’s account, can function like a “second drug middleman” system—prioritizing rebates in ways that can help inflate list-price effects and shift cost pressure onto people whose out-of-pocket costs tie to those pricing dynamics.
What the proposed consent order would require
According to the FTC’s consent-order package, the agreement is designed around three reader-facing goals: (1) reduce insulin out-of-pocket costs, (2) increase transparency, and (3) improve how community pharmacies are treated.
1) A “Copay Certainty Program” with fixed insulin caps. The proposed order would require Caremark to cap members’ out-of-pocket costs on insulin at $25 for a prescription claim with a 0–34 days’ supply, $50 for 35–68 days’ supply, and $75 for 69 or more days’ supply.
Access depends on whether a patient’s plan sponsor adopts a formulary that includes participating insulin products in the program—and the proposed terms allow a plan sponsor to opt out in writing.
2) Rules aimed at stopping out-of-pocket costs from being driven by inflated list-price benchmarks. The consent-order materials say Caremark’s “Standard Offering” for plan sponsors is designed so that members’ out-of-pocket costs for participating insulin products aren’t calculated based on list prices or other benchmarks that exceed the drug’s net price after rebates.
3) A “standard offering” that is meant to be fairer at the pharmacy counter. For retail community pharmacies, the proposal uses a specific definition: a retail pharmacy business dispensing prescriptions predominately in person at the point of sale through three or fewer retail store locations.
The proposed order also describes a cost-plus compensation approach: pharmacies would be paid based on their actual cost of acquiring prescription drugs plus a dispensing fee, plus additional payments for non-dispensing services. It also includes terms intended to prevent Caremark from excluding willing pharmacies that agree to the standard terms.
Finally, the FTC package includes requirements meant to address how Caremark handles “hub pharmacy” services that help patients connect to information about out-of-pocket cost pathways.
Timeline: comment period first, then final order
The FTC said it voted to accept the consent agreement for public comment, and that the public has 30 days to submit comments on the proposed consent agreement package.
Once the comment process is completed and the FTC moves toward final disposition, the Commission’s final consent order would carry legal force for future actions covered by the order.
What to watch next if you rely on insulin
Because the order is proposed, patients should expect any changes to roll out only after the consent-order process completes. Key things to watch:
- Whether the FTC issues a final order after the 30-day public-comment period.
- Whether your plan sponsor includes participating insulin products in the “Copay Certainty Program” and whether any opt-out applies to your plan.
- Whether pharmacies and plan portals start reflecting the program-based insulin cost pathways at or near the point of sale.
Sources
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