Three major health insurance companies, CVS, UnitedHealth, and Cigna, have filed a lawsuit to halt a Federal Trade Commission (FTC) investigation into their pricing practices for insulin.

• The pharmaceutical companies CVS Health, UnitedHealth Group, and Cigna filed a lawsuit against the Federal Trade Commission, arguing that the FTC's investigation into drug middlemen and high insulin prices in the U.S. is unconstitutional.
• The latest move in a bitter legal fight between the three largest pharmacy benefit managers in the U.S. and the FTC is a complaint.
• In September, the FTC filed a lawsuit against Caremark, Express Scripts, and Optum Rx, which are subsidiaries of CVS, Cigna, and UnitedHealth, respectively, in the agency's administrative court.

The Federal Trade Commission was sued on Tuesday by drug supply chain middlemen, who claimed that the agency's case against them over high insulin prices in the U.S. is unconstitutional.

The ongoing legal battle between the three largest pharmacy benefit managers in the U.S. and the FTC has resulted in a complaint being filed in the U.S. District Court for the Eastern District of Missouri.

In September, the FTC accused CVS's Caremark, Cigna's Express Scripts, and UnitedHealth's Optum Rx of using a "perverse" rebate system to increase their profits while increasing the cost of insulin for Americans.

An administrative judge hears the case after the FTC's in-house administrative process initiates a proceeding. The FTC commissioners then vote on the opinion.

The Tuesday complaint contends that the FTC's process infringes on the companies' due process rights under the Fifth Amendment. Additionally, the companies assert that the FTC's allegations pertain to private rights that must be adjudicated in federal court rather than in the agency's internal administrative court.

The companies claimed that the process was fundamentally unfair, arguing that commissioners and an administrative law judge were unconstitutionally protected from removal by the President, which made them immune to democratic accountability.

The complaint stated that such a broad effort to transform an industry through law enforcement would not be approved in a US district court.

FTC spokesperson Douglas Farrar stated on Tuesday that corporate giants often argue that a 110-year-old federal agency is unconstitutional to divert attention from their business practices that harm patients. He added that this tactic will not be successful.

In the U.S., PBMs play a pivotal role in the drug supply chain. They engage in negotiations with drug manufacturers for rebates on behalf of health plans, compensate pharmacies for prescriptions, and compile lists of medications that are covered by insurance.

The complaint against FTC Chair Lina Khan and two other commissioners was made a month after CVS, UnitedHealth Group, and Cigna demanded their recusal from the agency's in-house suit. In separate motions, the companies argued that all three commissioners have a history of making public statements that suggest a serious bias against Pharmaceutical Benefit Managers (PBMs).

The three companies, Caremark, Express Scripts, and Optum Rx, are owned by or linked to health insurers and collectively manage approximately 80% of the country's prescriptions, as per the FTC.