Florida is suing three insulin manufacturers, three pharmacy benefit managers and three rebate companies, accusing them of colluding to inflate prices for diabetes medication.
The defendants include Eli Lilly, Novo Nordisk and Sanofi, which supply more than 90% of the world’s insulin, according to state Attorney General James Uthmeier.
Also named in the antitrust lawsuit are CVS Caremark, Express Scripts and OptumRx, PBMs that process about 80% of U.S. prescriptions, rebate aggregators Zinc, Ascent and Emisar, and UnitedHealthcare Insurance.
The complaint, filed in Florida’s 11th Judicial Circuit in Miami-Dade County, alleges the drug manufacturers inflated published prices for insulin and related diabetes medications, then paid rebates and fees to the PBMs in exchange for preferred formulary placement.
Both groups profited when the costs increased, the attorney general said.
“These companies told Florida families they were working to make insulin affordable,” Uthmeier said in a Thursday press release. “Instead, they inflated the sticker price of a medicine people cannot live without and left Florida patients to pay it. My office is holding them accountable.”
In the news release, Uthmeier cites earlier testimony by a Lilly executive that of every $280 vial of the insulin brand Humalog, the company provides $210 to PBMs in rebates or discounts.
According to the lawsuit, insulin manufacturing costs “only a few dollars per vial.”
The complaint also covers pricing for GLP-1 and combination products including Ozempic, Trulicity, Victoza and Soliqua.
The lawsuit seeks a permanent injunction, damages, civil penalties and other relief to protect patients’ access “to affordable, life-saving medication,” the press release said.
Insulin has a published list price and a lower net the manufacturer keeps after rebates. Patients without insurance, in a deductible or on percentage-based coinsurance are charged a list price, Uthmeier said.
Patients who cannot live without prescribed insulin were left to pay the inflated list price, according to the lawsuit.
Insulin has a published list price and a lower net price the manufacturer keeps after rebates. Patients without insurance, who are in a deductible or who have percentage-based coinsurance can be exposed to the list price, according to the lawsuit.
The lawsuit says the pricing system has created significant financial burdens for some insulin users. It says approximately 14% of Americans who use insulin – more than 1.1 million people – experienced “catastrophic” spending on insulin, defined as spending at least 40% of their income remaining after food and housing expenses on insulin alone.
Separately, about one-in-four patients reported rationing their insulin because of its cost, according to the lawsuit.
About 2.3 million Florida adults have diabetes, according to the lawsuit.
The complaint also brings two counts under the Florida Deceptive and Unfair Trade Practices Act and one count under the Florida Antitrust Act.
