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Trumplandia rigs the game for dirty dealing PBMs in the FTC insulin lawsuit
https://ohiocapitaljournal.com/2025/...-want-to-know/The Federal Trade Commission late Tuesday stayed a lawsuit accusing pharmacy middlemen of gaming the system to inflate the price of insulin — a drug millions of Americans need to survive. When it did, it left experts in Ohio and elsewhere trying to figure out if President Donald Trump was trying to sabotage the commission’s work, or if it was simply part of his vendetta against Democrats.
Created in 1914, the FTC is tasked with stopping unfair trade practices — particularly those by big corporations that use their dominance to harm small businesses and consumers.
Starting around 1980, Republican and then Democratic administrations — which appoint the agency’s commissioners — greatly diminished the role of the FTC and the An rust Division of the Justice Department. The argument then prevailed that despite what the laws themselves said, the goal of an rust law was efficiency, which would supposedly deliver better outcomes for consumers.
But awareness has grown in recent years that the rise of big box stores, health conglomerates, and tech companies hasn’t been to the uniform benefit of consumers.
In response, the Biden administration began a new era of stepped-up enforcement of laws that had long been on the books. The FTC filed lawsuits against Amazon, to stop the Kroger-Albertson’s merger, and it sued giant health conglomerates. It accused the latter companies of unfairly driving up insulin prices at the expense of diabetics — especially those with low incomes.
That was the case that the FTC stayed on Monday.
The agency did so because two Republican commissioners had recused themselves from the case, saying they had conflicts of interest. A third Republican commissioner hasn’t yet been approved by the Senate. And Trump in March tried to fire the two Democratic appointees, Alvaro Bedoya and Rebecca Kelly Slaughter.
The case was to be heard by the commissioners. But now there aren’t any to hear it.
Bedoya and Slaughter are in court challenging the attempted firings, arguing that the president doesn’t have the power to simply decree a change in the structure of a regulatory commission created by Congress. The suit quotes the Federal Trade Commission Act, which says the president can only remove commissioners “for inefficiency, neglect of duty, or malfeasance in office.”
So long as that lawsuit plays out, the FTC suit against the pharmacy middlemen won’t.
It alleges that the big three pharmacy middlemen excluded cheaper generic forms of insulin from insurance coverage in order to extract larger rebates from manufacturers’ more costly products.
The three biggest middlemen, or pharmacy benefit managers, control nearly 80% of the insured drug transactions in the United Sates. Each is a part of a conglomerate that also owns a major insurer — UnitedHealth Group, CVS Health and Cigna-Express Scripts.
As middlemen, the benefit managers decide which drugs are covered, and which of those have low or no copayments. The FTC suit says that since 2012, they’ve been increasingly aggressive about demanding ever-larger, non-transparent rebates — their critics call them kickbacks — from manufacturers in exchange for covering their drugs.
With insulin, prices were effectively jacked up when the middlemen refused to cover some of the cheapest alternatives at all, the suit said.
