Federal Trade Commission staffers got more time Tuesday for settlement talks with OptumRx and Caremark that could end the agency's case accusing the pharmacy benefit managers of inflating insulin prices, with staffers citing considerable progress in the weeks since inking a deal with Express Scripts.

In a brief order Tuesday, the commission granted a joint request from staffers and OptumRx and Caremark to extend the pause put in place to allow settlement talks. The parties had sought more time Monday, seeking the extension for all deadlines, including for the summer trial and a hearing that had been set for March 5.

"Complaint counsel and respondents are making significant progress in settlement discussions. This extension of the stay will provide time for the parties to further advance these discussions and determine whether there is an opportunity to resolve this proceeding," the parties said in their joint filing.

Under Tuesday's order, the pause in the administrative case will run through March 24, pushing back oral arguments on the PBMs' motion to dismiss the claims to April 17 and the evidentiary hearing that had been set for a July 30 kickoff to Aug. 20.

The FTC declined to comment, and OptumRx did not immediately respond Tuesday to a press inquiry. David Whitrap, CVS Health's vice president of communications, declined to comment other than to reiterate that the talks "would enable CVS Caremark to avoid prolonged litigation and instead focus on its primary job of making prescription drugs more affordable in the United States."

The commission first hit pause in January as enforcers mulled a deal with Express Scripts, which was finalized in early February. Staffers sought a further extension Feb. 9, which the commission promptly granted, to facilitate talks with the remaining PBMs. That pause was set to expire Tuesday.

The FTC accuses the country's three largest pharmacy benefit managers of preventing patients from accessing lower-priced insulin drugs by using rebate schemes that prioritize medications with high list prices.

Pharmacy benefit managers negotiate prescription drug prices with pharmaceutical manufacturers for insurers and other benefit plans. The companies named in the case are all owned by larger healthcare conglomerates — Express Scripts by Cigna Group, OptumRx by UnitedHealth Group Inc. and Caremark by CVS, which also owns Aetna.

The commission said Feb. 4 that it had reached a "landmark settlement" with Express Scripts after it agreed to make major changes to its drug formulary practices. The FTC billed the changes as promising "up to $7 billion" in patient savings for out-of-pocket drug costs over the course of 10 years.

The companies have consistently argued that manufacturers alone set pharmaceutical prices and that benefit managers work to lower prices for insurers and others who pay for healthcare.

The commission's deal with Express Scripts bars the company from preferencing drugs with high wholesale costs in its formularies. It also requires out-of-pocket expenses to be based on a drug's net cost, rather than its artificially inflated list price.

Express Scripts agreed to offer plan sponsors ways to transition off of rebate guarantees as well, and to uncouple the compensation drugmakers pay to Express Scripts from drug list prices.

The company also agreed to provide covered access to the new direct-to-consumer platform TrumpRx and to bring its group purchasing organization, Ascent, back from Switzerland to the U.S.

The PBMs have their own case pending in federal court challenging the FTC's in-house administrative process on constitutional grounds. Like other similar cases, the companies allege the commission's in-house proceedings violate due process rights and their right to have the claims decided by a federal judge.

The companies urged an Eighth Circuit panel in November to reverse a lower court's refusal to issue a preliminary injunction that would pause the administrative case while the constitutional challenge plays out. A ruling remains pending.

Express Scripts also has a separate case accusing the FTC of defamation over an interim agency report on the PBM industry that was released ahead of the enforcement action. That case has been put on hold pending the outcome of the appeal in the constitutional challenge.

The FTC is represented in-house by Bradley S. Albert, Lauren Peay and Rebecca L. Egeland.

Caremark and Zinc Health Services are represented by Enu Mainigi, Craig D. Singer, Jonathan B. Pitt, Kathryn E. Hoover and Steven M. Pyser of Williams & Connolly LLP and Mike Cowie, Gregory P. Luib and Rani A. Habash of Dechert LLP.

Express Scripts, Evernorth Health Services, Medco Health Services and Ascent Health Services are represented by Daniel J. Howley, Charles F. Rule, Margot Campbell, Derek W. Moore and Justin T. Heipp of Rule Garza Howley LLP and Jennifer Milici, Perry A. Lange and John W. O'Toole of WilmerHale.

OptumRx and Emisar Pharma Services are represented by Ryan S. Appleby, Samuel Liversidge, Sophia A. Hansell, Kristen C. Limarzi, Michael J. Perry and Matthew C. Parrott of Gibson Dunn & Crutcher LLP.

The case is In the Matter of Caremark Rx et al., docket number 9437, before the Federal Trade Commission.