The Federal Trade Commission (FTC) settled a lawsuit against Express Scripts and its subsidiaries over allegations of price manipulation of insulin and limiting access to cheaper alternatives.[1][3][6] The FTC alleges that Express Scripts, along with Caremark and Optum Rx, which manage about 80% of US prescriptions, steered patients toward more expensive insulin because of higher rebates from manufacturers.[1][3][5] These practices led to an artificial increase in the list price of insulin; for example, the price of Eli Lilly's Humalog has risen from $21 in 1999 to over $274 in 2017.[1][5] As a result, vulnerable patients, such as those with co-pays, paid higher prices without the relief of rebates.[5] The FTC suspended proceedings against Express Scripts, Evernorth, and Ascent Health Services to consider a proposed settlement agreement that would settle all claims.[3] The three PBMs deny the allegations and say their practices reduce costs for patients.[3][4] The deal is subject to FTC approval.[3][6]