The Federal Trade Commission (FTC) has filed a lawsuit against the top three pharmacy benefit managers (PBMs)—UnitedHealth Group’s OptumRx, CVS Health’s Caremark, and Cigna’s Express Scripts—alleging they have artificially inflated insulin prices through a rebate system that prioritizes high rebates over affordable drug options. The FTC accuses these PBMs of excluding lower-cost insulin products from covered drug lists, resulting in higher out-of-pocket costs for patients. Collectively, these three PBMs manage around 80% of all U.S. prescriptions. The lawsuit aims to dismantle this 'perverse drug rebate system' and reduce drug prices, highlighting a broader effort by the Biden administration to address rising healthcare costs. The PBMs have criticized the FTC's actions, defending their practices and arguing that the lawsuit could inadvertently increase overall drug prices.