The Federal Trade Commission (FTC) has initiated legal action against major pharmacy benefit managers (PBMs), accusing them of artificially inflating insulin prices through questionable rebate practices. The lawsuit, which targets the biggest players in the drug middleman space, highlights concerns over a 'perverse' rebating system allegedly contributing to the high costs of insulin for consumers. In response, Express Scripts, one of the leading PBMs, has filed a lawsuit against the FTC for defamation, claiming that a recent FTC report is biased and inaccurate. This legal confrontation underscores the ongoing tensions and scrutiny within the pharmaceutical supply chain, as healthcare giants seek to protect their interests amidst increasing pressure for transparency and affordability in drug pricing.