Missouri becomes latest plaintiff in lawsuits against PBMs, drug companies over skyrocketing insulin prices
The state of Missouri has filed a lawsuit against numerous pharmacy benefit managers (PBMs) and drug manufacturers, accusing the lot of artificially jacking up the price of insulin, to the detriment of Medicaid.
In a court filing, 19 defendants were named in total, including the three biggest PBMs—CVS Caremark, UnitedHealth’s Optum Rx and Cigna’s Express Scripts—along with drug companies, including Eli Lilly, Novo Nordisk and Sanofi.
Missouri Attorney General Catherine Hanaway’s complaint—much like similar lawsuits brought by the Federal Trade Commission (FTC), the state of Texas and Philadelphia-based Jefferson Health, among others—centers on the role of PBMs in setting reimbursement rates and participating in an alleged rebate scheme with manufacturers that artificially raises the price, passing off the savings to select pharmacies or health plans. while leaving others with higher bills.
Central to Hanaway’s claim is the Missouri Merchandising Practices Act, which she argues renders this business practice illegal. She points to extreme discrepancy in insulin pricing: Where a vial from the same manufacturer costs $5 overseas, that price rises to upwards of $400 in the U.S.
This creates an unfair financial burden for people in the state, the lawsuit contends.
“Uninsured diabetics must pay the full, point-of-sale prices—based on the artificial prices generated by the Insulin Pricing Scheme—every time they fill their prescriptions. In Missouri, nearly 400,000 Missouri residents are uninsured,” the court filing reads. “Approximately 18% of uninsured Missouri residents are diabetic. As a direct result of the insulin pricing scheme, the prices uninsured Missouri residents with diabetes pay for the at-issue life-sustaining drugs has skyrocketed over the last fifteen years.”
Hanaway is asking a federal court to intervene, arguing that the rebate model and pharmacy favoritism are de facto collusion.
“When a PBM combines with a pharmacy, it has [an] increased incentive to collude with manufacturers to keep certain prices high,” the lawsuit reads. “These perverse incentives still exist today with respect to both retail and mail order pharmacies housed within the PBMs’ corporate families.”
Similar litigation pending
A currently-stalled antitrust case brought by the FTC also names the same big three PBMs as defendants, those being Caremark, Optum Rx and Express Scripts. The agency alleges defendants engaged in collusion to jack the price of insulin in a manner very similar to the claims made by Missouri.
Similarly, Texas announced a lawsuit against the PBMs in October 2024. It also named Eli Lilly, Novo Nordisk and Sanofi as defendants—the same three drug companies being sued by Missouri. Once again, that case is focused on the price of insulin.
Most recently, Jefferson Health—a large not-for-profit health system in Philadelphia—filed a lawsuit against all six of the above defendants, alleging the rebate pricing model artificially controls and raises the price of insulin. That complaint was filed on Dec. 30.
In separate statements, the main three PBMs at the center of these lawsuits have denied any wrongdoing. All the cases are still pending.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.