Missouri Attorney General Hanaway Files Suit Against Pharmacy Benefit Managers For Insulin Pricing Scheme

Missouri Attorney General Hanaway Files Suit Against Pharmacy Benefit Managers For Insulin Pricing Scheme

JEFFERSON CITY, Mo. - Today, Missouri Attorney General Catherine Hanaway announced that her Office has filed suit against 19 Pharmacy Benefit Manager (PBM) companies and drug manufacturers operating in Missouri. For years, PBMs and manufacturers have manipulated Missouri's health care markets, resulting in skyrocketing prices of life-sustaining insulin medication.

"At a time when health care costs continue to soar, we are taking a stand against insulin price manipulation and fraud," said Attorney General Hanaway. "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."

As a direct result of the Insulin Pricing Scheme, the prices uninsured Missouri residents with diabetes pay for the at-issue life-sustaining drugs have increased rapidly over the past fifteen years. In Missouri, nearly 450,000 Missouri residents are uninsured, and approximately 18 percent of those uninsured Missouri residents are diabetic. Notably, manufacturers published prices in Missouri of $300-$400 for the same at-issue drugs that were sold in other countries for less than the equivalent of $5 USD. Missouri diabetics rely on the PBMs to achieve the lowest prices for insulin and to construct formularies designed to improve their health and lower costs, only to be deceived with artificially inflated list prices.

"Access to life-sustaining insulin should not be restricted by radical pricing practices that disproportionately harm families," said Interim Deputy Attorney General Jeremiah Morgan, "PBMs have found a way to game the system for their mutual benefit-the Insulin Pricing Scheme, and consumers have said 'enough.'"

The petition, filed in St. Louis County Circuit Court, details how certain PBMs knowingly engaged in a conspiracy and violated Section 301.210, RSMo, and the Missouri Merchandising Practices Act (MMPA), which prohibits deceptive and unfair business practices. The suit names 19 defendants, including PBMs and manufacturing defendants:

• Evernorth Health, INC. (Formerly Express Scripts Holding Company) (located in St. Louis County);
• Express Scripts, Inc. (located in St. Louis County);
• Express Scripts Administrators, LLC;
• ESI Mail Pharmacy Service, Inc. (located in St. Louis County);
• Express Scripts Pharmacy, Inc. (located in St. Louis County);
• Medco Health Solutions, Inc.;
• CVS Health Corporation;
• CVS Pharmacy, Inc.;
• Caremark Rx, LLC;
• CaremarkPCS Health, LLC;
• Caremark, LLC;
• UnitedHealth Group, Inc.;
• Optum, Inc.;
• OptumRx, Inc.;
• OptumInsight Life Sciences, Inc.;
• OptumInsight, Inc.
• Eli Lilly and Company;
• Novo Nordisk Inc.; and
• Sanofi-Aventis U.S. LLC.

Together, these health care administration conglomerates make virtually all of the diabetes medications available in Missouri. The PBMs are solely responsible for the price of almost every single vial of insulin sold in Missouri and across the United States. In the US, 1 in 4 diabetics can no longer afford their diabetes medication and are forced to ration and skip doses, as a direct result of the Insulin Pricing Scheme.

The Attorney General's Office is asking the Court to take the following actions to protect Missouri consumers and enforce state law:

• Declare this Insulin Pricing Scheme Unlawful: The lawsuit seeks a court order to determine that Defendants have unlawfully received a financial windfall and have violated, and are violating, the Missouri Merchandising Practices Act and Missouri common law by committing deceptive and/or unfair practices against Missouri consumers, by being unjustly enriched, and by conspiring to commit unlawful acts.
• End Predatory Behavior: Grant comprehensive injunctive relief and permanently enjoin Defendants from engaging in the above described unfair and deceptive acts and practices.
• Require PBMs Pay What is Owed: The suit calls for defendants to pay all restitution, damages, disgorgement, and other relief that may be owed to Missouri consumers affected by Defendants' unlawful acts and practices.

If successful, this action will hold Pharmacy Benefit Managers and manufacturers accountable, require financial restitution, and send a clear message to other businesses: If you deceive Missouri consumers, you will face the full force of the law.

To view the full petition, click here.