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FTC sues insulin middlemen, saying they pocket billions while patients face high costs

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FTC sues insulin middlemen, saying they pocket billions while patients face high costs

This picture shows a unit dedicated to the production of insulin pens at the factory of the U.S. pharmaceutical company Eli Lilly in Fegersheim, France, on Oct. 12, 2015.

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Millions of people with diabetes need insulin to survive. For years, many of them have been forced to pay exorbitant prices for a product that’s inexpensive to make. Now, the federal government is targeting one part of the system behind high insulin prices.

While out-of-pocket costs have gone down for many people to $35 a month, questions remain on how the drug became so expensive in the first place. In a new lawsuit filed Friday, the Federal Trade Commission said it’s going after one link in the chain: pharmacy benefit managers (PBMs).

The FTC brought action against the top PBMs — CVS Health’s Caremark Rx, Cigna’s Express Scripts, and United Health Group’s OptumRx — saying the companies created a “perverse drug rebate system” that artificially inflates the cost of insulin. If the suit is successful, it could further drive down costs for patients at the pharmacy counter.

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PBMs are essentially the middlemen between drug manufacturers and insurance providers. Their job is to reduce drug prices. But the process is complex and opaque, and critics say they’re actually driving prices up for patients.

The FTC said a big issue is that PBMs’ revenue is tied to rebates and fees — which are based on a percentage of a drug’s list price. Essentially, in the case of insulin, when the drug costed more, it generated higher rebates and fees for PBMs.

“Even when lower list price insulins became available that could have been more affordable for vulnerable patients, the PBMs systemically excluded them in favor of high list price, highly rebated insulin products,” the FTC said in a press release on Friday.

The three PBMs named in the FTC lawsuit make up about 80% of the market. According to the suit, the PBMs collected billions of dollars in rebates and fees while insulin became increasingly unaffordable.

Over the last two decades, the cost of the lifesaving drug shot up 600% — forcing many Americans with diabetes to ration their medication and jeopardize their health. In 2019, one 1 of 4 insulin patients was unable to afford their medication, according to the FTC. Some people have died.

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The Pharmaceutical Care Management Association, which represents PBMs, denied many of the allegations in FTC’s suit, including that PBM rebates correlate with higher list prices. “This action not only fails to accurately consider the role of the entire prescription drug supply chain, but disregards positive progress, supported by PBMs, in making insulin more affordable for patients,” the PCMA said in a statement.

Over the years, about 20 states have passed laws or programs to limit the amount that patients pay for insulin. But some of the biggest changes happened in the last two years.

In 2022, Congress passed the Inflation Reduction Act, which capped the out-of-pocket insulin costs for Medicare patients. Last year, Eli Lilly, Novo Nordisk and Sanofi — the three companies that control some 90% of the U.S. insulin supply — also pledged to slash some of their prices.

On Friday, Rahul Rao, the FTC’s Bureau of Competition deputy director, said the investigation into PBMs shed light on the “concerning and active role” that the three manufacturers have played in causing insulin to be unaffordable for many people with diabetes. Rao said the three companies further inflated their list price of their insulin products “in response to the PBMs’ demand for higher rebates.”

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Rep. Ilhan Omar rushed by man on stage and sprayed with liquid at town hall event

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Rep. Ilhan Omar rushed by man on stage and sprayed with liquid at town hall event

A man is tackled after spraying an unknown substance at US Representative Ilhan Omar (D-MN) (L) during a town hall she was hosting in Minneapolis, Minnesota, on January 27, 2026. (Photo by Octavio JONES / AFP via Getty Images)

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Rep. Ilhan Omar, D-Minn., was rushed by a man during a town hall event Tuesday night and sprayed with a liquid via a syringe.

Footage from the event shows a man approaching Omar at her lectern as she is delivering remarks and spraying an unknown substance in her direction, before swiftly being tackled by security. Omar called on Homeland Security Secretary Kristi Noem to resign or face impeachment immediately before the assault.

Noem has faced criticism from lawmakers on both sides of the aisle in the aftermath of the fatal shooting of 37-year-old intensive care nurse Alex Pretti by federal officers in Minneapolis Saturday.

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Omar’s staff can be heard urging her to step away and get “checked out,” with others nearby saying the substance smelled bad.

“We will continue,” Omar responded. “These f******* a**holes are not going to get away with it.”

A statement from Omar’s office released after the event said the individual who approached and sprayed the congresswoman is now in custody.

“The Congresswoman is okay,” the statement read. “She continued with her town hall because she doesn’t let bullies win.”

A syringe lays on the ground after a man, left, approached Representative Ilhan Omar, a Democrat from Minnesota, during a town hall event in Minneapolis, Minnesota, US, on Tuesday, Jan. 27, 2026. The man was apprehended after spraying unknown substance according the to Associated Press. Photographer: Angelina Katsanis/Bloomberg via Getty Images

A syringe lays on the ground after a man, left, approached Representative Ilhan Omar, a Democrat from Minnesota, during a town hall event in Minneapolis, Minnesota, US, on Tuesday, Jan. 27, 2026. The man was apprehended after spraying an unknown substance according to the Associated Press. Photographer: Angelina Katsanis/Bloomberg via Getty Images

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Omar followed up with a statement on social media saying she will not be intimidated.

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As Omar continued her remarks at the town hall, she said: “We are Minnesota strong and we will stay resilient in the face of whatever they might throw at us.”

Just three days ago, fellow Democrat Rep. Maxwell Frost of Florida said he was assaulted at the Sundance Festival by a man “who told me that Trump was going to deport me before he punched me in the face.”

Threats against Congressional lawmakers have been rising. Last year, there was an increase in security funding in the wake of growing concerns about political violence in the country.

According to the U.S. Capitol Police, the number of threat assessment cases has increased for the third year in a row. In 2025, the USCP investigated 14,938 “concerning statements, behaviors, and communications” directed towards congressional lawmakers, their families and staff. That figure represents a nearly 58% increase from 2024.

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Video: F.A.A. Ignored Safety Concerns Prior to Collision Over Potomac, N.T.S.B. Says

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Video: F.A.A. Ignored Safety Concerns Prior to Collision Over Potomac, N.T.S.B. Says

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F.A.A. Ignored Safety Concerns Prior to Collision Over Potomac, N.T.S.B. Says

The National Transportation Safety Board said that a “multitude of errors” led to the collision between a military helicopter and a commercial jet, killing 67 people last January.

“I imagine there will be some difficult moments today for all of us as we try to provide answers to how a multitude of errors led to this tragedy.” “We have an entire tower who took it upon themselves to try to raise concerns over and over and over and over again, only to get squashed by management and everybody above them within F.A.A. Were they set up for failure?” “They were not adequately prepared to do the jobs they were assigned to do.”

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The National Transportation Safety Board said that a “multitude of errors” led to the collision between a military helicopter and a commercial jet, killing 67 people last January.

By Meg Felling

January 27, 2026

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Families of killed men file first U.S. federal lawsuit over drug boat strikes

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Families of killed men file first U.S. federal lawsuit over drug boat strikes

President Trump speaks as U.S. Secretary of Defense Pete Hegseth looks on during a meeting of his Cabinet at the White House in December 2025.

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Relatives of two Trinidadian men killed in an airstrike last October are suing the U.S. government for wrongful death and for carrying out extrajudicial killings.

The case, filed in Massachusetts, is the first lawsuit over the strikes to land in a U.S. federal court since the Trump administration launched a campaign to target vessels off the coast of Venezuela. The American government has carried out three dozen such strikes since September, killing more than 100 people.

Among them are Chad Joseph, 26, and Rishi Samaroo, 41, who relatives say died in what President Trump described as “a lethal kinetic strike” on Oct. 14, 2025. The president posted a short video that day on social media that shows a missile targeting a ship, which erupts in flame.

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“This is killing for sport, it’s killing for theater and it’s utterly lawless,” said Baher Azmy, legal director of the Center for Constitutional Rights. “We need a court of law to rein in this administration and provide some accountability to the families.”

The White House and Pentagon justify the strikes as part of a broader push to stop the flow of illegal drugs into the U.S. The Pentagon declined to comment on the lawsuit, saying it doesn’t comment on ongoing litigation.

But the new lawsuit described Joseph and Samaroo as fishermen doing farm work in Venezuela, with no ties to the drug trade. Court papers said they were headed home to family members when the strike occurred and now are presumed dead.

Neither man “presented a concrete, specific, and imminent threat of death or serious physical injury to the United States or anyone at all, and means other than lethal force could have reasonably been employed to neutralize any lesser threat,” according to the lawsuit.

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Lenore Burnley, the mother of Chad Joseph, and Sallycar Korasingh, the sister of Rishi Samaroo, are the plaintiffs in the case.

Their court papers allege violations of the Death on the High Seas Act, a 1920 law that makes the U.S. government liable if its agents engage in negligence that results in wrongful death more than 3 miles off American shores. A second claim alleges violations of the Alien Tort Statute, which allows foreign citizens to sue over human rights violations such as deaths that occurred outside an armed conflict, with no judicial process.

The American Civil Liberties Union, the Center for Constitutional Rights, and Jonathan Hafetz at Seton Hall University School of Law are representing the plaintiffs.

“In seeking justice for the senseless killing of their loved ones, our clients are bravely demanding accountability for their devastating losses and standing up against the administration’s assault on the rule of law,” said Brett Max Kaufman, senior counsel at the ACLU.

U.S. lawmakers have raised questions about the legal basis for the strikes for months but the administration has persisted.

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—NPR’s Quil Lawrence contributed to this report.

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