The three biggest pharmacy benefit managers and two pharmaceutical giants colluded to send insulin prices soaring, Attorney General Jason Miyares says.

He is suing pharmacy benefit managers Express Scripts, CVS’ Caremark unit and UnitedHealth Group’s Optum business as well as the drug-makers Novo Nordisk and Sanofi, asserting they violated the Virginia Consumer Protection Act.

The lawsuit said the firms worked together for more than a decade to send insulin prices ever higher, at a cost to patients of billions of dollars.

The firms “increased the prices of their diabetes medications up to 1000%, often down to the decimal point within a few days of each other,” the lawsuit said.

“Remarkably, nothing about these medications has changed; more recent $350 insulin is the exact drug defendants originally sold for $20,” it added.

Miyares said the artificial prices hit thousands of Virginians who depend on insulin to stay alive.

“For years, a group of powerful companies artificially drove up the cost of life-saving diabetes medication, enriching themselves while Virginians paid inflated prices just to survive,” Miyares said.

“That system operated without transparency, deceived Virginians, and put profits over patients for far too long,” he said.

The lawsuit, filed in Richmond Circuit Court, seeks an injunction to stop the firms from acting to artificially raise insulin prices, as well as restitution for affected patients, disgorgement of ill-gotten gains, and fines and other relief allowed under the state consumer protection act.

The pharmacy benefit managers and drug-makers sued could not be reached immediately for comment on the 147-page lawsuit, filed Friday, shortly before 3 p.m.

The day before Miyares filed the lawsuit, Gov.-elect Abigail Spanberger said she would push for legislation to reform the way pharmacy benefit managers set prices for patients, health plans and pharmacies.

Both the pharmacy benefit managers and the manufacturers benefited from ballooning prices, the lawsuit said, echoing findings from U.S. Senate hearings, the Federal Trade Commission and several economists.

The manufacturers profited as sellers do when prices rise and costs don’t, while the pharmacy benefit managers gained from their role as middlemen able to negotiate ever-larger discounts in the form of price rebates that they did not then mostly pass on to their ultimate customers: patients, the lawsuit said.

The pharmacy benefit managers “granted preferred formulary position to each at-issue drug in exchange for large Manufacturer Payments and inflated prices,” the lawsuit said. The three firms control roughly 80% of the prescription drug market, it noted.

“The Manufacturers coordinated with the PBM Defendants to exclude lower-priced diabetes medications from the PBMs’ formularies because increasing sales and utilization of higher-priced diabetes medications is more profitable,” it said.

Inflated prices helped the manufacturers win hundreds of millions of dollars in tax breaks by basing their deductions for donated insulins on the inflated list price, the lawsuit said.

Because the pharmacy benefit managers also decide which pharmacies are included in their networks, they can use that power to set the prices they pay pharmacists for dispensing drugs.

That allows the pharmacy benefit managers to pocket the difference between what medication costs pharmacists to stock and what patients and their insurers pay, the lawsuit said.

The inflated prices, meanwhile, mean the pharmacy benefit managers also make money on the difference between what they pay for their discounted drugs and what their mail-order and brick-and-mortar pharmacies charge, the lawsuit said.

It said “high-level representatives and corporate officers from both PBM and Manufacturer Defendants attend” Pharmaceutical Care Management Association’s conferences “to meet in person to discuss their shared business opportunities within the pharmaceutical industry.”

https://www.pilotonline.com/2025/12/21/miyares-sues-pharmacy-over-soaring-insulin-prices/