Two Connecticut cities filed federal lawsuits against Cigna, CVS Health and UnitedHealth Group — targeting their pharmacy benefit managers — over an alleged “insulin pricing scheme,” according to January filings in the U.S. District Court for the state.
Along with Express Scripts, Evernorth, CVS Caremark and Optum Rx, Norwalk and New Haven’s lawsuits focus on drug manufacturers Eli Lilly and Co., Novo Nordisk and Sanofi, as well as group purchasing organizations.
The cities characterize themselves as operators of self-funded plans and said they were “significantly overcharged” for insulin. The complaints accuse parties of fraudulent activity and violations of federal anti-racketeering laws, and state and federal antitrust laws. Norwalk and New Haven are seeking monetary damages, restitution, attorney fees and injunctions to halt this conduct.
“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,” a CVS Caremark spokesperson said in a statement shared with Becker’s. “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.”
A statement from Optum Rx echoed this, adding the PBM “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.”
“PBMs, like Optum Rx, are the key counterweight to pharmaceutical companies’ otherwise unchecked monopoly power to set and raise drug prices,” the company said.
Novo Nordisk, however, also called the allegations “meritless.”
“We intend to vigorously defend against these claims,” a spokesperson said in a statement. “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.”
The lawsuits were filed shortly before the Federal Trade Commission reached a settlement with Cigna’s Express Scripts, aiming to lower out-of-pocket costs for drugs like insulin by $7 billion over a decade. The Labor Department had also pushed for greater transparency between PBMs and self-insured group health plans through proposed regulation.
Becker’s contacted Cigna, Eli Lilly and Sanofi and will update this story if more information becomes available.
