CVS Health’s pharmacy benefit manager Caremark has reached a settlement with the Federal Trade Commission over its use of rebates and the handling of TrumpRx purchases.
Under the agreement, Caremark will count consumers’ TrumpRx purchases toward their plan deductibles, a move FTC Chairman Andrew Ferguson says will deliver billions of dollars in savings on drug prices.
TrumpRx.gov connects cash-pay customers to drugmaker websites offering discounted medicines, but the platform has operated outside of insurance, limiting its usefulness for consumers working toward deductibles.
The settlement also requires Caremark to give clients the option to opt out of rebate payment models entirely, addressing a long-standing concern among independent pharmacies and plan sponsors.
Caremark must additionally offer to reimburse independent pharmacies at acquisition cost plus a fee, a concession that could reshape competitive dynamics across retail pharmacy.
The company has separately committed to capping insulin out-of-pocket costs at $25 per month for eligible consumers, a significant affordability measure for diabetic patients.
For manufacturers and plan sponsors, the agreement signals that cash-pay discount channels and traditional benefit design are starting to converge in meaningful ways.
Across the Atlantic, Europe’s largest pharmaceutical market has moved to tighten branded drug pricing considerably, with consequences that reach far beyond Germany’s borders.
German lawmakers approved a sweeping health insurance reform that more than doubles the mandatory rebate drugmakers must pay on patented medicines, with most provisions taking effect on January 1, 2027.
The fixed manufacturer rebate on branded drugs rises from 7% to 15.5%, after an earlier proposal for a variable, expenditure-linked rebate was dropped following sustained industry pressure.
German Health Minister Nina Warken said the law finally “created the basis for stable finances” in the country’s statutory health insurance system, which faces a projected deficit of 15.3 billion euros in 2027.
Drugmaker Merck, among others, pushed back forcefully against the legislation, calling the law a “hard blow to Germany’s pharmaceutical sector.”
Global drugmakers had mounted a pressure campaign modelled on their recent success in the UK, where the government agreed to increase medicine spending as part of a deal linked to avoiding US tariffs.
That campaign secured a partial concession with the fixed rebate structure, but it was ultimately insufficient to prevent the broader reform from passing into law.
By cutting what it pays for patented medicines, Germany widens the pricing gap between the United States and Europe, placing it squarely at the centre of the Trump administration’s most-favoured-nation pricing push.