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FTC Reaches Second Insulin Pricing Settlement: Comparing the Caremark and ESI Orders
◆ Published
18 July 2026
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opportunities
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Fusion42 · 18 July 2026 · Fusion42 review
The FTC settled its second major insulin pricing case against Caremark, requiring PBMs to delink rebates from formulary placement, cap patient out-of-pocket costs, and provide transparent cost reporting. The order mirrors an earlier ESI settlement but carves out Medicare, Medicaid, and Exchange plans from key requirements.
This Wire brief sits within Fusion42's coverage of Digital Health. Wire is Fusion42's founder-focused intelligence feed: each story is connected to the funds and startups it names — every one with a live profile on Raise or Scout — so founders can follow the capital and the momentum behind the headline rather than just the headline itself. Wire analysis is one of the live surfaces Arthur reasons over.
◆ The Wire takeaway
If you sell pharmacy software, PBM automation, or transparency tools to commercial plans, the business model just changed - rebates are now a liability, not a lever, and every contract needs real-time cost reporting built in. The carve-out for Medicare and Medicaid means two separate tech stacks are now required.
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- CVS settles with FTC, agrees to count TrumpRx drug purchases towards insurance | Reuters16 July 2026
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◆ Topics
Digital Health · pbm-regulation · insulin-pricing · ftc-enforcement · rebate-reform · pharmacy-reimbursement