### Major Pharmacy Benefit Managers Sue FTC Over Insulin Pricing Case

CVS Health, UnitedHealth Group, and Cigna have launched a lawsuit against the Federal Trade Commission, arguing that the agency's actions against drug middlemen responsible for high insulin prices in the United States are unconstitutional. This newly filed complaint further intensifies the ongoing legal confrontation between the three leading pharmacy benefit managers (PBMs) in the country and the FTC.

In September, the FTC took action by suing CVS’s Caremark, Cigna’s Express Scripts, and UnitedHealth’s Optum Rx. The lawsuit, initiated in the FTC's administrative court, accused these PBMs and other intermediaries in the drug supply chain of implementing a skewed rebate system that inflates insulin prices to boost their own profits, ultimately burdening American consumers.

The latest complaint from the PBMs has been lodged in the U.S. District Court for the Eastern District of Missouri. The companies argue that the FTC’s in-house administrative process infringes on their constitutional due process rights under the Fifth Amendment. They claim that issues related to their private rights should be addressed in federal court rather than through the FTC’s administrative system. According to CVS, UnitedHealth, and Cigna, the FTC’s process is "fundamentally unfair" and lacks democratic accountability, as both the commissioners and the administrative law judge are insulated from removal by the President.

Douglas Farrar, an FTC spokesperson, responded by stating that large corporations frequently label the 110-year-old federal agency as unconstitutional to deflect from practices that the FTC claims harm patients by driving up the costs of life-saving medications like insulin. Farrar emphasized that such arguments are unlikely to succeed.

Pharmacy benefit managers like Caremark, Express Scripts, and Optum Rx play a crucial role in the U.S. drug supply chain. They negotiate rebates with manufacturers, reimburse pharmacies, and compile lists of medications covered by insurance plans. Collectively, these PBMs, tied to health insurers, manage approximately 80% of all prescriptions in the nation.

This complaint follows a move just a month earlier when the same companies called for FTC Chair Lina Khan and two other commissioners to recuse themselves from the case, citing past public statements that allegedly demonstrated significant bias against PBMs. The legal battle appears set to continue as both sides stake their claims over the constitutionality and fairness of the ongoing proceedings.