Attorney General Daniel Cameron files lawsuit against pharmacy benefit managers for insulin pricing scheme

August 2, 2023 – Kentucky Attorney General Daniel Cameron filed a lawsuit against CVS Caremark, Optum RX, and Express Scripts for their role in an insulin pricing scheme.

According to a news release from the Attorney General’s Office, the lawsuit alleges that manufacturers and the pharmacy benefit managers have been working together to increase insulin prices.

PBM’s have leverage over insulin manufacturers and have allegedly been using that leverage to increase their profits by raising insulin prices, instead of negotiating lower prices for their customers.

The insulin manufacturers allegedly raised their reported prices and then refunded a portion of that price to PBMs through rebates, discounts, credits, and administration fees. This process has left many diabetic Kentuckians unable to afford insulin.

Executives for PBMs recently testified that between 75 and 84 cents of every dollar spent on insulin goes directly to affiliates of PBMs.

According to the American Diabetes Association, more than 450,000 Kentuckians have been diagnosed with Diabetes. They also say that people with diabetes have medical expenses nearly 2.3 times higher than those without diabetes.

The Center for Disease Control says that missing insulin doses can lead to high blood sugar, or hyperglycemia, and may cause diabetic ketoacidosis which can be life-threatening. When your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy, your liver will break down fat for fuel and produce ketones. High levels of ketones in the body can cause:

  • Being very thirsty.
  • Urinating more than usual.
  • Fast, deep breathing.
  • Flushed face.
  • Fruity smelling breath.
  • Headache.
  • Muscle stiffness or aches.
  • Being very tired.
  • Stomach pain.
  • Nausea and vomiting.

Attorney General Cameron says, “The unlawful business practices that drove these increases have to end, and normal market forces must be allowed to lower the cost of insulin for all Kentuckians.”

By Julie Bryson, WPSD
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