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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.
Frederick Florin/AFP via Getty Images
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Frederick Florin/AFP via Getty Images
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.
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.
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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Additional work by Jana Tauschinski
Oil and gas tanker location and destination data are from Kpler. The map shows the latest position for vessels with an active AIS signal on April 19–20, filtered by minimum capacity thresholds: crude tankers of at least 50,000 deadweight tonnage (DWT); oil product tankers of at least 55,000 DWT; oil/chemical tankers of at least 40,000 DWT; LNG carriers of at least 150,000 cubic metres; and LPG carriers of at least 50,000 cubic metres. Net fossil fuel import data by country are based on Ember analysis of the IEA World Energy Balances 2023.
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Roommate faces murder charges in deaths of 2 University of South Florida doctoral students
A 26-year-old man is facing two counts of first-degree murder in the deaths of two University of South Florida doctoral students who went missing last week, local authorities said Saturday.
The Hillsborough County Sheriff’s Office in Florida said that evidence presented to the state attorney’s office resulted in the charges against Hisham Abugharbieh, the roommate of Zamil Limon, one of the doctoral students.
Abugharbieh is accused of premediated murder with a weapon. He was arrested on Friday, the same day Limon was found dead.
The family of Nahida Bristy, the other doctoral student, told CBS News that police said she is also likely dead. That is based on the volume of blood discovered at Abugharbieh’s residence, which he shared with Limon.
“Police told us she is no longer with us,” Bristy’s brother, Zahid Prato, said early Saturday.
The family was told her body may never be found and police believe she may have been dismembered, according to Prato.
CBS News has reached out to police for more information.
Authorities said in a statement Saturday they were still searching for Bristy.
Limon’s remains were found on the Howard Franklin Bridge in Tampa Friday morning, Chief Deputy Joseph Maurer with the Hillsborough County Sheriff’s Office said. His cause of death was pending autopsy results.
Deputies with the sheriff’s office took Abugharbieh into custody on Friday after responding to a domestic violence call at a home in the Lake Forest Community, a neighborhood near USF’s Tampa campus, officials said. He also faces charges of domestic violence and evidence tampering, as well as a charge of failing to report a death to law enforcement.
Limon and Bristy, both 27, had last been seen in the Tampa area on April 16.
Limon was studying the use of AI in environmental science and was set to present his doctoral thesis this week, his family said. Bristy is studying chemical engineering.
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Rubio’s Absence From Iran Talks Highlights Stay-at-Home Role
When President Barack Obama negotiated a nuclear deal with Iran more than a decade ago, his point man was Secretary of State John Kerry. Over 20 months of talks, Mr. Kerry met with his Iranian counterpart on at least 18 different days, often several times per day.
High-level nuclear diplomacy was a natural role for the top U.S. diplomat. Secretaries of state traditionally take the lead on the country’s biggest diplomatic tasks, from arms control treaties to Israeli-Palestinian agreements.
But as President Trump prepares to send a delegation to the latest round of U.S.-Iran talks in Pakistan this weekend, his secretary of state, Marco Rubio, will remain where he often does: at home.
Mr. Rubio did not attend the last U.S. meeting with Iran earlier this month. Nor did he join several meetings held over the past year in Geneva and Doha. Mr. Rubio has also been absent from U.S. delegations abroad working to settle the war in Ukraine and Israel’s war in Gaza. Despite a long period of crisis and war in the region, he has not visited the Middle East since a brief stop in Israel last October.
In recent months, Mr. Rubio — consumed with his second role, as Mr. Trump’s national security adviser — has not traveled much at all.
During the Biden administration, Secretary of State Antony J. Blinken made 11 foreign trips from January 2024 to late April 2024, stopping in roughly three dozen cities, according to the State Department. So far this year, Mr. Rubio has visited six foreign cities, including a stop in Milan for the 2026 Winter Olympics.
Mr. Trump has outsourced much of his diplomacy to others, including his friend Steve Witkoff, a wealthy associate from the world of Manhattan real estate, and his son-in-law, Jared Kushner. Mr. Witkoff and Mr. Kushner have spearheaded diplomacy with Israel, Ukraine and Russia, as well as Iran, whose delegation they will meet for the second time this month in Islamabad, Pakistan’s capital.
Mr. Rubio’s distance from the trenches of diplomacy reflects his dual role on Mr. Trump’s national security team. For the past year, he has served as the White House national security adviser even while leading the State Department — the first person to do so since Henry A. Kissinger in the mid-1970s.
The secretary of state runs the State Department, overseeing U.S. diplomats and embassies worldwide, as well as Washington-based policymakers. Working from the White House, the national security adviser coordinates departments and agencies, including the State Department, to develop policy advice for the president.
The twin roles reflect Mr. Rubio’s influence with Mr. Trump, and offer him a way to maintain it. For Mr. Rubio, less time abroad means more time at the side of an impulsive president prone to making critical national security decisions at any moment.
As Mr. Witkoff, Mr. Kushner and Vice President JD Vance met with Iranian officials in Pakistan earlier this month, Mr. Rubio was at Mr. Trump’s side at an Ultimate Fighting Championship event, noted Emma Ashford, an analyst of U.S. diplomacy at the nonpartisan Stimson Center in Washington. “Rubio clearly prefers to stay close to Trump,” Ms. Ashford said.
Mr. Rubio accepted the national security adviser job on an acting basis last May after Mr. Trump reassigned the job’s previous occupant, Michael Waltz. But officials say that Mr. Rubio is expected to keep it indefinitely.
That arrangement is not inherently bad, Ms. Ashford added. And she noted that previous presidents had entrusted major diplomatic tasks to people other than the secretary of state. President Joseph R. Biden Jr. delegated his C.I.A. director, William J. Burns, to handle diplomacy with Russia and cease-fire negotiations between Israel and Hamas, for instance.
But she echoed the complaints by many current and former diplomats that Mr. Rubio seems less like someone performing both jobs than a national security adviser who sometimes shows up at the State Department. “I do think it’s to the detriment of the whole department of State and to America’s ability to conduct diplomacy in general that we effectively have the secretary of state position sitting vacant,” she said.
Tommy Pigott, a State Department spokesman, contested such claims. “Anyone trying to paint Secretary Rubio’s close coordination with the White House and other agencies as a negative could not be more wrong,” he said. “We now have an N.S.C. and State Department that are totally in sync, a goal that has eluded past administrations for decades.”
Mr. Rubio divides his time between the State Department and the White House, often spending time at both in the same day. In an interview with Politico last June, Mr. Rubio said he visited the State Department “almost every day.”
While there, he often meets with visiting dignitaries before returning to the White House. Last week, Mr. Rubio presided over a meeting at the State Department between Lebanese and Israeli officials that set the stage for a cease-fire in Lebanon.
His twin jobs “really do overlap in many cases,” he said. “In many cases you end up being in the same meetings or in the same places; there’s just one less person in there, if you think about it,” Mr. Rubio added. “A lot of people would come to Washington, for example, for meetings, and they’d want to meet with the national security adviser and then meet with me as secretary of state. Now they can do both in one meeting.”
Asked about his travel schedule during a news conference last December, Mr. Rubio said he had less reason to travel abroad because “we have a lot of leaders constantly coming here” to visit Mr. Trump at the White House. Mr. Rubio also joins Mr. Trump’s foreign trips in his capacity as national security adviser.
Many national security veterans call the arrangement unwise, saying that both jobs are extremely demanding and incompatible with one another.
It was not easy even for Mr. Kissinger, who had firmly established himself over more than four years as national security adviser before convincing President Richard M. Nixon to let him take on an additional role as secretary of state in 1973. (In a reversal of Mr. Rubio’s approach, Mr. Kissinger was in constant motion, including a round of Middle East shuttle diplomacy that kept him on the road for 33 straight days.)
“In general, it’s a mistake to combine those roles,” said Matthew Waxman, who held senior roles at the National Security Council, State Department and the Pentagon during the George W. Bush administration.
“That said, it’s not necessarily a bad thing that a dual-hatted Rubio is so offscreen right now,” Mr. Waxman added. “Especially while so much attention is focused on high-wire diplomacy with Iran, someone needs to manage foreign policy around the rest of the world.”
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