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 manufacturers inflated published prices for insulin and related diabetes medications, then paid rebates and fees to the PBMs in exchange for preferred formulary placement.
All the defendants profited when the costs increased, the attorney general said.
"That sticker price lands a higher cost on the consumers and on the independent small-business pharmacists than the ultimate negotiated price that's reached behind closed doors after the manufacturers discuss with the PBMs and the aggregators and ultimately get rebates and kickbacks and promotions where they get much larger margin," Uthmeier said a Wednesday news conference in Tampa.
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Uthmeier cited earlier testimony by a Lilly executive that of every $280 vial of the insulin brand Humalog, the company provides 75%, or about $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.
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.
"You as the patient and the consumer are stuck with the ultimate price tag," Uthmeier said. "So here in Florida, we're not going to stand for this."
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.
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