CHARLOTTE — Two counties in the Charlotte area have filed lawsuits in the last few weeks over the price of insulin. Gaston County and Lincoln County join hundreds of similar lawsuits against drug makers, including ones from the cities of Greensboro and Winston-Salem.
Stacey Simms says her son was diagnosed with diabetes in 2006, right before he turned two years old. “At the time, it was just overwhelming, frightening,” she said.
She says the price was especially scary. “It can be very frightening to feel like you don’t know what the price is going to be and this feeling of powerlessness as an individual when you go into the pharmacy,” she said.
Patients aren’t the only ones concerned. Many employers are suing over insulin pricing.
“Just as patients are paying a lot, the employers are paying an awful lot, and a lot of times that’s a government employer. It’s ridiculous,” said Simms, who has become an advocate and expert on diabetes and insulin.
There are hundreds of cases pending, including the ones from Gaston and Lincoln counties.
They say over the past two-plus decades, they’ve overpaid millions of dollars for insulin through their employees’ health plans. So, they’re suing the manufacturers including Lilly, Novo Nordisk, and Sanofi.
“The manufacturers have colluded together to do what’s called lockstep price increases, meaning that if one increases their price to adjust for the rebates and fees, the others will at the same time to ensure that no one individual manufacturer sticks out as far as their price increases,” Brandon Bogle, a lawyer for plaintiffs, told Action 9 investigator Jason Stoogenke, who has been tracking concerns over insulin pricing for years.
The plaintiffs are also suing Pharmacy Benefit Managers (PBMs), including CVS Caremark, Express Scripts, and Optum Rx. PBMs are middlemen between drug companies and insurance companies. Their job is to negotiate prices both sides can live with so patients can get the medicine they need for affordable prices.
“They have used that control to extract payments from manufacturers, and those manufacturers’ payments have been termed rebates, administrative fees, service fees. Different terms are used, but it’s all the same thing. It’s a kickback scheme,” Bogle said.
Lilly says, “These copycat lawsuits are baseless. In the only three cases where insulin pricing allegations have been put to their proof, the plaintiffs have either dropped their case, lost their motion to proceed as a class action, or settled for no money. These outcomes speak for themselves. Lilly has been working for years to reduce insulin out-of-pocket costs for people with diabetes, against the headwinds of those — like parties filing these lawsuits — that benefit from rebates and 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, we cut insulin prices by 70%, and the average monthly out-of-pocket cost for Lilly insulin is just $17.16.”
Novo Nordisk says, “It believes that the allegations against it are meritless, and we intend to vigorously defend against these 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.”
Sanofi says, “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, 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 2023 – the average net price of our insulins declined by 76%. Sanofi believes that no one should struggle to pay for their insulin, regardless of their insurance status or income level, which is why we have a suite of innovative and patient-centric savings programs to help people reduce their prescription medicine costs. More information can be found at teamingupfordiabetes.com.”
CVS Caremark says, “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. CVS Caremark has led the way in driving down the cost of insulin for all patients: insured, uninsured, and underinsured. Our members on average pay less than $25, far below list prices and far below the Biden Administration’s $35 cap. Further, we also provide access to $25 insulin to every American, whether insured or uninsured, through our ReducedRx program at every one of our 67,000 network pharmacies and more than 9,000 CVS pharmacies.”
Express Scripts says, “We typically can’t comment on pending litigation,” but did provide its own data showing its “average member” pays only “$22 per month.”
Optum RX says, “These baseless actions demonstrate a profound misunderstanding of how drug pricing works. For many years, Optum Rx has aggressively and successfully negotiated with drug manufacturers and taken additional actions to lower prescription insulin costs for our health plan customers and their members, who now pay an average of less than $18 per month for insulin. PBMs, like Optum Rx, are the key counterweight to pharmaceutical companies’ otherwise unchecked monopoly power to set and raise drug prices.”
If this makes it to trial, the plaintiffs’ lawyers expect it to be around the end of 2026 or the beginning of 2027. If the plaintiffs win, patients wouldn’t get reimbursed for out-of-pocket expenses (because the cities and counties are the plaintiffs), but they could expect prices to drop for them and their employers. The plaintiffs’ lawyers say they anticipate similar cases involving other drugs.
This is the kind of litigation where cases are grouped together, but it’s not a class action. There is a separate class action going on right now over what consumers claim companies owe them directly.
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