JEFFERSON CITY — Missouri Attorney General Catherine Hanaway’s office has filed a lawsuit in St. Louis Circuit Court against 19 pharmacy benefit managers (PBMs) and drug manufacturers alleging a coordinated “Insulin Pricing Scheme” that has artificially inflated the cost of life-saving insulin and harmed diabetic residents across the state.
The complaint accuses the defendants of manipulating Missouri’s health care markets to drive up prices and deceive consumers, particularly uninsured individuals with diabetes who are forced to shoulder the brunt of skyrocketing costs.
Hanaway
In the lawsuit, Hanaway contends that PBMs, which are third-party intermediaries that negotiate drug prices, manage prescription benefits and process claims, along with major insulin manufacturers, have colluded to set and maintain inflated list prices for insulin and other diabetes drugs, contrary to fair market competition and state consumer protection law.
The suit asserts that this practice unfairly enriches the defendants while exacting an undue financial burden on patients dependent on insulin for survival.
“At a time when health care costs continue to soar, we are taking a stand against insulin price manipulation and fraud,” Hanaway said in a statement. “It is quite clear that the health care administration conglomerates do not want the prices for diabetes medications to go down, choosing profit over affordable health care for people at risk. Missourians deserve a fair and just marketplace and we demand nothing less.”
The lawsuit underscores stark disparities in drug pricing, noting that the same insulin products that sell for $300 to $400 per vial in Missouri have been sold for less than the U.S. equivalent of $5 in other countries.
The complaint alleges that insured patients and pharmacies are misled by PBMs’ formularies, which are purportedly designed to lower costs but instead reflect and perpetuate inflated list prices.
According to the complaint, nearly 450,000 Missourians are uninsured, and roughly 18% of those uninsured residents have diabetes, a population particularly vulnerable to the effects of high insulin prices.
The suit cites broader national figures showing a significant number of diabetics rationing or skipping doses because they cannot afford their medication.
The defendants named in the lawsuit include major PBMs and affiliated entities such as Evernorth Health, Express Scripts, CVS Health Corporation and its affiliates, Caremark Rx and related subsidiaries, UnitedHealth Group and Optum entities, as well as leading insulin manufacturers Eli Lilly, Novo Nordisk and Sanofi-Aventis U.S. LLC.
Together, these companies are said to control virtually the entire insulin supply chain in Missouri and the broader United States.
The complaint invokes Missouri’s Merchandising Practices Act and state common law, alleging deceptive and unfair business practices, unjust enrichment and conspiracy.
It seeks multiple forms of relief from the court: a declaration that the alleged insulin pricing scheme is unlawful; a permanent injunction to halt predatory conduct; and restitution, disgorgement and damages owed to Missouri consumers affected by the defendants’ actions.
Interim Deputy Attorney General Jeremiah Morgan noted the human toll of the pricing practices.
“Access to life-sustaining insulin should not be restricted by radical pricing practices that disproportionately harm families,” Morgan said. “PBMs have found a way to game the system for their mutual benefit — the Insulin Pricing Scheme — and consumers have said ‘enough.’”