FTC’s Landmark Antitrust Investigation Suspended
The Federal Trade Commission’s groundbreaking antitrust case against the nation’s three largest pharmacy benefit managers has been placed on hold following President Donald Trump’s controversial dismissal of two Democratic commissioners. The case, which targeted alleged insulin price-fixing schemes that increased costs by up to 1,200% over two decades, now sits in regulatory limbo as the agency lacks the necessary quorum to proceed.
Originally approved in September 2024 through a 3-0 vote—after both Republican commissioners recused themselves—the investigation aimed to address skyrocketing insulin prices affecting millions of Americans with diabetes. The administrative complaint specifically targeted CVS Caremark, Cigna’s Express Scripts, and UnitedHealth’s OptumRx, along with their respective group purchasing organizations.
Inside the Administrative Complaint
The FTC’s complaint, filed on September 20, 2024, alleged that the three dominant pharmacy benefit managers had effectively “rigged pharmaceutical supply chain competition” by creating and exploiting a “perverse drug rebate system” that prioritized high manufacturer rebates over patient affordability.
Former FTC Chair Lina Khan, alongside commissioners Rebecca Slaughter and Alvaro Bedoya, approved the administrative complaint in a party-line vote after Republican commissioners Melissa Holyoak and Andrew Ferguson recused themselves without public explanation. The complaint documented how insulin prices had risen dramatically, placing essential medication beyond reach for many patients.
How Administrative Adjudication Works
Unlike standard federal court proceedings, the FTC case operates through the agency’s internal administrative adjudication process. This specialized system allows the Commission to address violations of consumer protection and competition laws through its own regulatory framework.
The process typically progresses from a formal complaint through an investigation phase before proceeding to a hearing presided over by an Administrative Law Judge. Following this hearing, the FTC commissioners would normally issue a final decision on the matter. However, the recusals and subsequent firings have effectively halted this process.
Political Upheaval Paralyzes the FTC
The case’s progress was first disrupted when Khan resigned from the Commission on January 31, 2025, after Trump appointed Ferguson as the new Chair earlier that month. The situation deteriorated further on March 18 when Trump abruptly terminated the agency’s only remaining Democratic commissioners—Slaughter and Bedoya—without cause.
This move directly challenged the longstanding legal precedent established in Humphrey’s Executor v. United States, a 90-year-old Supreme Court ruling that specifically limits presidential authority to remove FTC commissioners without justification. The dismissed commissioners filed a lawsuit on March 27, describing their terminations as a “direct violation of a century of federal law and Supreme Court precedent.”
Official Stay Order Details
With the FTC lacking a quorum, both the Complaint Counsel and the respondent companies jointly requested an expedited stay of proceedings on March 31, 2025. The stay was granted under FTC Rule 0.7(b), which permits the General Counsel to act when all parties waive their right to Commission review.
Key provisions in the stay order include:
- A minimum pause period of 105 days
- An evidentiary hearing scheduled for 225 days after the stay is lifted
- A requirement for all parties to engage in good-faith discussions regarding future scheduling
Former Chair Khan publicly criticized the stay on social media as “a gift to the PBMs” that would allow them to continue their pricing practices without regulatory scrutiny.
Implications for Patients and the Market
The administrative pause creates several immediate consequences:
- Continued High Insulin Prices: With regulatory intervention delayed, millions of diabetes patients will continue facing exorbitant costs for essential medication.
- Regulatory Uncertainty: The unprecedented dismissal of commissioners has raised serious questions about regulatory independence and the future enforcement of antitrust laws.
- Bipartisan Reform Delayed: Despite general agreement across party lines that PBM reform is necessary, meaningful action may now be postponed until at least 2026.
Future Outlook
As the procedural standoff continues, pharmaceutical industry stakeholders, patient advocates, and legal experts are closely monitoring developments. The resolution of the legal challenge to the commissioners’ dismissals and the eventual reconstitution of the FTC’s quorum will determine when—or if—the agency can resume its investigation into alleged price manipulation in the insulin market.
The case represents a critical test of both regulatory authority and the government’s ability to address pharmaceutical pricing practices that directly impact public health and consumer welfare.
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