ST. LOUIS (KMOX) - KMOX News has learned that St. Louis County is suing a long list of drug companies, pharmacies, and pharmacy benefit managers, alleging a conspiracy to inflate the insulin prices.
The lawsuit filed in U.S. District Court for the Eastern District of Missouri cites federal racketeering law, alleging defendants engaged in an insulin pricing scheme.
The complaint names manufacturers of insulin and other products used to treat diabetes, including Eli Lilly, Novo Nordisk, and Sanofi. It also lists multiple Pharmacy Benefit Managers (PBMs) as defendants, including CVS Health Corporation and Evernorth Health, Inc. (formerly known as Express Scripts Holding Company based in St. Louis).
The case is being handled by Simmons Hanly Conroy law firm in Alton, Illinois.
In the court filing, St. Louis County contends that in its role providing health benefits to employees, retirees and their dependents, it paid "millions of dollars in overcharges to the detriment of its beneficiaries and taxpayers."
Millions of people with diabetes rely on daily insulin to maintain their health.
The lawsuit contends manufacturers have raised prices of insulin products "in tandem" saying "the Manufacturer Defendants increased their prices by the same amounts, down to the decimal point, within a few days of one another" boosting the price of insulins 1000% in the last decade. The case further claims a portion of that list price is paid to pharmacy benefit managers as rebates, discounts, credits and other fees. That, the plaintiff contends, gives those insulin products "preferred status" and creates a "false, artificially inflated price".
The suit claims PBMs "wield enormous control" over drug prices and purchasing behavior by establishing approved drug lists (formularies).
St. Louis County alleges that the market dominance by the pharmacy benefit managers named in the case, means the County has to accept the formularies (approved drug lists) offered.
The lawsuit points out the three corporations listed, control approximately 80% of the PBM market and are housed within the same corporate families as three of the largest insurance companies in the United States.
The suit seeks a stop to what it contends is a "civil conspiracy" and asks for restitution, punitive damages and penalties
KMOX News reached out to multiple defendants in the case.
In response, CVSHealth sent the following statement: "Pharmaceutical companies alone are responsible for the prices they set in the marketplace for the products they manufacture. Nothing in our agreements prevents drug manufacturers from lowering the prices of their insulin products and we would welcome such an action. Allegations that we play any role in determining the prices charged by manufacturers for their products are false, and we intend to vigorously defend against this baseless suit."
Drug maker Eli Lilly and Company sent this statemen: "This complaint is baseless and should be dismissed, just like cases brought by other local governments have been. It’s the local governments filing these lawsuits—not Lilly—who decide the terms of the rebate arrangements they now say are improper, including whether to pass rebates on to people who take insulin. Lilly has been working for years to reduce insulin out-of-pocket costs for people with diabetes, against the headwinds of a healthcare system that incentivizes others—like the parties filing these lawsuits—to choose higher list-price medicines over lower-priced options. Lilly was the first and still only company to cap what people pay at $35 per month for all of our insulins, and the average monthly out-of-pocket cost for Lilly insulin is even lower, $20.48. We also cut insulin prices by 70% and automatically cap monthly out-of-pocket costs at $35 or less wherever possible, which should drive that average even lower."
Drug manufacturer Sanofi provided this statement to KMOX News: "While we will not comment on the specifics of the allegations, Sanofi’s pricing practices have always complied with the law and the company is committed to helping patients access the medicine they need at the lowest possible price. Following through on that commitment requires Sanofi to navigate a complex environment. Under the current system, fees and savings negotiated by health insurance companies and PBMs through rebates are not consistently passed through to patients in the form of lower co-pays or coinsurance. As a result, patients’ out-of-pocket costs continue to rise while - between 2012 and 2022 – the average net price of our insulins declined by 58%."
From Novo Nordisk: "Novo Nordisk believes that the allegations in the lawsuit are without merit, and we intend to vigorously defend against the claims. While we will not comment further about pending litigation, we recognize that not all patient situations are the same and we have a number of different insulin affordability offerings available through NovoCare. Importantly, we continually review and revise our offerings as well as work with diverse stakeholders to create solutions for differing patient needs. A $35.00 insulin option called MyInsulinRxTM is available from Novo Nordisk for eligible patients. The program builds on existing Novo Nordisk insulin affordability options and is intended to further lower out-of-pocket costs for eligible people living with type 1 and type 2 diabetes."
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