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Insulin is a medicine many people cannot skip. Pennsylvania says its price climbed to more than 10 times what it once was, because big drug companies and their middlemen worked together. That is the state’s claim, and none of it has been proven in court. But it raises a big question: who sets the price of a medicine you need to stay alive, and why did it climb so high?
On Oct. 13, Pennsylvania Attorney General Dave Sunday filed a lawsuit in the state’s Commonwealth Court. It names three insulin makers: Eli Lilly, Novo Nordisk, and Sanofi. It also names pharmacy benefit managers, or PBMs, including Express Scripts, CVS Caremark, and Optum Rx. PBMs are middlemen that manage drug benefits for insurers and employers. The lawsuit says these companies’ actions raised insulin prices by more than 1,000%.
Sunday says the companies did not compete on price. He says they coordinated instead, and patients paid the bill at the pharmacy counter. In the lawsuit, the state accuses them of breaking its consumer protection law, getting rich unfairly, and conspiring, which means working together to do something wrong. These are claims, not findings. To understand them, it helps to see how an insulin price gets set.
Pennsylvania Says Drug Makers and Middlemen Worked Together Instead of Competing on Price
The insulin price system has a few moving parts. A drug maker sets a list price for insulin. A PBM decides which drugs an insurance plan covers and bargains over rebates, which are money back from the drug maker. Patients often pay based on the list price. Pennsylvania says that setup let companies keep list prices high. It says each side gained while patients paid more.
The lawsuit points to a timeline. It says PBMs began merging in 2003, which gave them more buying power. The state says insulin prices began to rise sharply that same year. It also cites a 2018 study in BMJ Global Health. That does not prove the claim. But it shows how the state tells its story: fewer, bigger players, and higher prices over time. Courts will decide if the evidence holds up.
The companies have not been shown replying in the reports we reviewed. Drug makers and PBMs have faced similar claims before. Earlier this year, the Federal Trade Commission announced settlements with Caremark and Express Scripts. The case against Optum Rx was withdrawn so the agency could consider a proposed agreement. Oregon and Florida also sued over insulin this year. So Pennsylvania’s case is part of a larger wave.
Pennsylvania Says 1.3 Million Residents Have Diabetes, and Many Cannot Skip Insulin
The numbers show why the state cares. Pennsylvania says about 1.3 million people there live with diabetes, and 3.5 million more have prediabetes, a warning stage. The attorney general’s office says diabetes costs the state an estimated $16.4 billion a year. It also says nearly 1 in 4 people with diabetes earn less than $25,000 a year. For those families, a higher price can mean hard choices.
Insulin is not a medicine people can easily delay. Without it, people with diabetes can develop kidney failure, need amputations, or die, the Pennsylvania Capital-Star reports. Even now, many people report rationing, which means taking less insulin than prescribed. Sunday said the alleged “scheme to artificially inflate pricing to maximize company profits” potentially harmed millions of Pennsylvanians. The state has not yet proven that in court.
Today, many people pay much less for insulin. The Capital-Star says insulin costs no more than $35 a month in most cases. Medicare caps it at $35 per covered insulin, and the three makers have programs with the same price for many people who are not on Medicare. So this case looks back at how prices climbed. It also asks the court to change how insulin is priced going forward.
The Lawsuit Seeks Money Back and Rule Changes, and You Can Check Your Own $35 Options Now
If Pennsylvania wins, the state could get money for people it says were harmed. The lawsuit asks for restitution, which means paying people back, plus civil penalties, which are fines. It also asks the court to order changes to how insulin pricing works, so prices move toward fair market levels and patients have more choices. A court has not decided any of this. Cases like this often take a long time.
You do not have to wait for the court to pay less. If you are on Medicare, you pay no more than $35 a month for each covered insulin. If you are not, ask your doctor or pharmacist about savings programs from Lilly, Novo Nordisk, and Sanofi, which offer $35 monthly prices to many people. Rules and eligibility differ, and the programs are voluntary, so check the details first.
There is a twist in this story. The three drug makers named in the lawsuit also run $35 programs that help many patients today. Both facts can be true. A company can offer help now and still be accused of causing higher prices in the past. That is why this case matters beyond one state. It asks how the price of a life-saving drug should be set, and who should keep an eye on it.
This article is general information, not medical or legal advice. Talk to your doctor or pharmacist about your own costs.