Insulin Overpricing Lawsuits
Ongoing cases allege that PBMs and insulin manufacturers artificially increased the cost of insulin, impacting self-funded health plans, their members, and beneficiaries. Law firms are investigating insulin overpricing on behalf of self-funded healthcare plans and their holders, which may include governmental bodies (cities, counties, and states) and unions.
What Do We Know About the Rising Cost of Insulin?
Insulin prices have skyrocketed in the last 20 years. Even though the medication is almost a century old, production costs are dropping, and few improvements have been made since its initial formulation. Since 2003, its list price has increased by more than 1000%, significantly more than the inflation rate for consumer products and services.
Although there are many widely accessible effective therapies, such as insulin, the cost of treating diabetes throughout the United States is very high. 14% of U.S. insulin users, or 1.2 million people, spend “catastrophic” sums on medication, meaning they spend no less than 40% of their post-subsistence income on it, according to a Yale study from 2022.
Who May Bring a Complaint for Insulin Overpricing and Whom Are They Suing?
The price of insulin, a vital diabetes medication, has increased dramatically and unjustifiably, resulting in significant losses for self-funded healthcare plans and those who own those plans. For these prospective claimants, our legal counsel is looking into possible cases.
To hold the many organizations controlling the insulin market accountable, including setting its prices, our law firm collaborates with a group of nationally renowned law firms.
Pharmacy Benefit Managers
89 percent of the pharmacy benefit manager (PBM) industry is controlled by three PBMs, as per the National Center for Policy Analysis (PBM Resources):
- Express Scripts
- CBS Caremark
- OPTUMRx
Insulin Manufacturers
Three pharmaceutical companies own 99% of the market share for insulin by value and 96% of the market share by volume, according to a 2019 report titled “Health Economics, An Perspective on Global Access to Insulin”:
- Novo Nordisk
- Eli Lilly
- Sanofi
Why Have Insulin Prices Skyrocketed?
Production costs have fallen due to practical and better operations, in contrast to the dramatic increase in insulin prices. According to a September 2018 study, a fair price for a person’s annual supply of human insulin must be between $48 and $71 while also generating considerable profits for manufacturers. Another study suggests insulin producers make money by charging less than $2 for each vial. Yet, the average diabetic spent $5,705 on insulin in 2016.
A Fraction of Insulin Profits Spent on Research & Development
Since the 1990s, the formula for insulin has remained unchanged. However, only a tiny portion of the manufacturers’ excessive earnings are allocated to research and development (R&D), with most investments directed toward improving delivery systems rather than modifying the drug’s composition.
For instance, Eli Lilly spent $395 million between 2014 and 2018 on research and development. While its insulin line generated $22.4 billion in revenue during that time, the business spent $1.5 billion on sales and marketing. Similarly, Sanofi only invested $902 million in the research and development of insulin, but their insulin-related products generated almost $37 billion in net revenue.
The otherwise baffling subject of why insulin prices are so high has only one rational response left: greed.
What Are the Main Legal Issues and Causes of Action Involving Insulin Overpricing?
Legal claims are filed based on the misconduct of PBMs and insulin manufacturers. These claims may include allegations of violations of the Racketeer Influenced and Corrupt Organizations Act (RICO), deceptive and unfair trade practices, unjust enrichment, and other potential claims. We are filing claims on behalf of our clients for these alleged violations.
Through these claims, we demand monetary damages and disgorgement for the excessive insulin prices that self-funded healthcare plans and their members have previously paid. Our efforts are focused on preventing such rates from being charged in the future.
What Compensation and Recourse May Be Recovered in a Complaint Alleging Insulin Overpricing?
Insulin overpricing litigation seeks a substantial monetary settlement and fair compensation for those affected.
Possible solutions include:
- Claimants may seek compensation for unjustly paid money on behalf of insured beneficiaries due to artificially raised insulin costs. In some cases, damages awarded may be tripled to account for unjustifiable expenses incurred and to deter similar behavior from defendants and other entities in the future.
- To stop the insulin pricing scheme, an injunctive remedy is needed. It would guard against potential financial harm to self-funded plans, including their members.
- Restitution of ill-gotten gains by PBMs as well as manufacturers
- Punitive damages are meant to make up for past wrongdoing and deter future wrongdoing.
The Diabetes Epidemic: at the Mercy of Excessively High Insulin Pricing
Every day, more than 7 million people need insulin. Because diabetes is so common and severe, insulin is a crucial, life-saving drug.
Approximately 88 million Americans have prediabetes, and over 34.2 million (or 10.5%) have diabetes. Although there are viable treatments for the condition, diabetes is the seventh most significant cause of mortality in the nation. About 275,000 Americans per year die from diabetes as the primary cause.
After its discovery in 1921, insulin was initially obtained from animals. The first biosynthetic human insulin, Humulin, was developed in 1978 and was approved by the FDA on October 28, 1982. Since the 1980s, there have been limited scientific advancements in insulin.
How Does the Rising Price of Insulin Affect People With Diabetes?
The rising price of insulin significantly impacts people with diabetes, both financially and medically. Insulin is a life-saving medication that is essential for managing diabetes, a chronic condition that affects how the body regulates blood sugar. However, the increasing cost of insulin has created numerous challenges for individuals with diabetes.
Financial Burden
The rising price of insulin has resulted in a substantial financial burden for people with diabetes. Many individuals with diabetes require daily insulin injections or insulin pumps to effectively manage their blood sugar levels. The high cost of insulin can result in increased out-of-pocket expenses for individuals, even with insurance coverage. Some individuals may face difficult choices, such as cutting back on other expenses or sacrificing other essential needs to afford their insulin medication. This financial strain can lead to increased stress, anxiety, and even non-adherence to prescribed insulin regimens, which can have severe health consequences.
Access Barriers
The increasing cost of insulin has also resulted in access barriers for people with diabetes. Some individuals may struggle to afford insulin due to a lack of insurance coverage, high deductibles, or co-pays. It can result in delayed or inadequate treatment, poorly managed blood sugar levels, and an increased risk of diabetes-related complications such as heart disease, kidney disease, and nerve damage. In some cases, individuals may resort to rationing or skipping insulin doses, which can be life-threatening and result in diabetic ketoacidosis, a severe and potentially fatal condition.
Health Consequences
The rising price of insulin can have severe health consequences for people with diabetes. Insulin is essential for regulating blood sugar levels, and inadequate access to insulin can result in poorly controlled diabetes. Uncontrolled diabetes can lead to serious health complications, including nerve damage, vision problems, kidney damage, and cardiovascular disease. In extreme cases, untreated diabetes can even result in a coma or death. Additionally, the stress and anxiety caused by the financial burden of insulin costs can negatively impact the mental health and overall well-being of individuals with diabetes.
Advocacy and Awareness
The rising price of insulin has led to increased advocacy and awareness efforts by patient organizations, healthcare providers, and policymakers. There have been calls for transparency in pricing, increased competition, and affordability measures to ensure that insulin remains accessible and affordable for people with diabetes. Some states and countries have implemented laws or policies to address the rising cost of insulin, such as price caps, generic alternatives, and importation options. However, more action is needed to address the issue comprehensively and ensure that individuals with diabetes can afford and access the life-saving medication they need to manage their condition effectively.
The rising price of insulin has significantly impacted people with diabetes, resulting in financial burdens, access barriers, health consequences, and increased advocacy and awareness efforts. It is crucial to address this issue to ensure that individuals with diabetes can afford and access the insulin they need to manage their glucose levels and condition effectively and prevent serious health complications.
Affordable Alternatives to Expensive Insulin
Affordable alternatives to expensive insulin have become a critical focus for patients, healthcare providers, and policymakers seeking to mitigate the financial burden of diabetes management. As the cost of insulin continues to rise, exploring and promoting accessible options is essential for ensuring that individuals can affordably manage their condition without compromising their health or financial stability. Here are several strategies and alternatives that have been proposed or implemented to address the issue:
1. Generic Insulin – Encouraging the development and availability of generic versions of insulin can help introduce competition into the market and drive down prices. Generic insulin products, which are bioequivalent to brand-name formulations, offer a more affordable alternative for patients who struggle with the high cost of branded medications. Efforts to streamline the regulatory approval process for generic insulin and overcome barriers to market entry can expand access to these cost-effective options.
2. Biosimilar Insulin – Biosimilar insulin, which is highly similar to existing biologic formulations, represents another promising avenue for cost savings. By leveraging advances in biotechnology, biosimilars offer comparable efficacy and safety to originator products at a lower cost. Encouraging the development and adoption of biosimilar insulin products can enhance affordability and expand treatment options for patients with diabetes.
3. Public Manufacturing Initiatives – Public manufacturing initiatives, such as government-led production or partnerships with nonprofit organizations, aim to produce insulin at a lower cost and distribute it at an affordable price. By leveraging economies of scale and bypassing the profit motive of private pharmaceutical companies, public manufacturing efforts can help ensure equitable access to insulin for all patients, regardless of their financial means.
4. Price Regulation and Transparency – Implementing regulations to cap insulin prices or increase transparency in pricing practices can help prevent pharmaceutical companies from exploiting their market dominance to overcharge for insulin. By establishing pricing standards and requiring manufacturers to justify price increases, policymakers can promote fair competition and hold drugmakers accountable for their pricing decisions, ultimately benefiting patients and reducing healthcare costs.
5. Patient Assistance Programs – Patient assistance programs offered by pharmaceutical companies, nonprofit organizations, and government agencies provide financial assistance to eligible individuals who cannot afford their insulin medication. These programs may offer discounts, coupons, or free medication to qualifying patients, helping to bridge the gap between the cost of insulin and patients’ ability to pay.
6. Community Health Centers and Clinics – Community health centers and clinics often offer sliding-scale fees or discounted medication programs for patients with limited financial resources. By providing comprehensive diabetes care, including insulin therapy, in a community-based setting, these healthcare facilities help ensure that underserved populations have access to affordable treatment options.
7. International Importation – Importing insulin from international markets where prices are lower can serve as a temporary solution to alleviate the burden of high insulin costs in the United States. Although importation carries logistical and regulatory challenges, exploring avenues for safe and legal importation of insulin can provide relief for patients facing financial hardship due to inflated domestic prices.
By pursuing these and other innovative approaches, stakeholders can work together to address the affordability crisis surrounding insulin and ensure that all individuals with diabetes have access to the medication they need to manage their condition effectively and lead healthy, fulfilling lives.
How to File a Lawsuit Against Insulin Companies?
Filing a lawsuit against insulin companies involves several steps and considerations to ensure that your legal claim is properly prepared and pursued. Here’s an overview of the process:
1. Consultation with Legal Counsel – Before initiating a lawsuit, it’s crucial to seek guidance from an experienced attorney who specializes in pharmaceutical litigation, particularly cases involving drug pricing and antitrust violations. Attorney Cristina Hinds can evaluate your case, advise you on your legal rights and options, and help you navigate the complexities of the legal system.
2. Gathering Evidence – Building a strong case against insulin companies requires gathering evidence to support your claims of overpricing, anticompetitive behavior, or other wrongdoing. This may involve obtaining documents, emails, financial records, and other materials that demonstrate the company’s actions and their impact on patients’ prescription costs.
3. Identifying Plaintiffs – If you’re filing a class action lawsuit on behalf of a group of patients who have been affected by high insulin prices, it’s essential to identify and represent the interests of potential plaintiffs. This may involve reaching out to individuals who have purchased insulin medications at inflated prices and inviting them to join the lawsuit as named plaintiffs or class members.
4. Drafting the Complaint – The next step is to draft a formal complaint outlining the allegations against the insulin companies and the legal basis for your claims. The complaint should clearly articulate the harm suffered by patients as a result of overpriced insulin, the specific actions of the defendants that constitute wrongdoing, and the relief sought by the plaintiffs.
5. Filing the Lawsuit – Once the complaint is prepared, it must be filed with the appropriate court and served on the defendants according to legal procedures. This initiates the formal legal process and sets the stage for litigation proceedings, including discovery, motion practice, and potentially trial.
6. Discovery Phase – During the lawsuit’s discovery phase, both parties exchange case-relevant information and evidence. This can involve depositions, interrogations, document demands, and expert witness testimony. Discovery enables each side to gather facts and construct their own cases in advance of trial.
7. Motion Practice – Throughout the course of the lawsuit, both parties may file motions with the court seeking various forms of relief, such as dismissal of certain claims, summary judgment, or sanctions against the opposing party. Motions play a critical role in shaping the legal issues to be decided by the court and resolving disputes between the parties.
8. Settlement Negotiations – In many cases, lawsuits against insulin companies are resolved through settlement negotiations rather than proceeding to trial. Settlement negotiations may take place at various stages of the litigation process and involve discussions between the parties’ attorneys to reach a mutually acceptable resolution that provides compensation to affected patients and implements reforms to address the underlying issues.
9. Trial (if necessary) – If a settlement cannot be reached, the case may go to trial, when the parties submit their evidence and arguments before a judge or jury. The trial procedure consists of opening speeches, witness testimony, cross-examination, exhibit presentation, and closing arguments. Ultimately, the judge or jury will make a decision based on the evidence provided and the applicable legislation.
10. Enforcement of Judgment – If the plaintiffs prevail in the lawsuit, the court will enter a judgment in their favor, which may include monetary damages, injunctive relief, or other remedies. The judgment must be enforced to ensure that the defendants comply with the court’s orders and provide relief to affected patients as required by law.
Filing a lawsuit against insulin companies is a complex and challenging undertaking, but with the assistance of experienced legal counsel and diligent preparation, patients can seek justice for the harm caused by overpriced insulin and hold pharmaceutical companies accountable for their actions.
Why Choose Our Law Firm
Are you struggling to afford insulin? You’re not alone. Many individuals with diabetes face the burden of skyrocketing insulin prices, which can be a matter of life or death. If you or a loved one has been affected by the overpricing of insulin, you may have legal options.
At Hinds Injury Law Las Vegas, our experienced legal team is here to help you explore the possibility of filing an insulin overpricing lawsuit against pharmaceutical companies responsible for unjustifiably high insulin costs. You deserve affordable life-sustaining medication, and we’re ready to fight for your rights.
Contact us today at (702) 940-1234 or set an appointment or consultation to discuss your case and take action against insulin overpricing. Your health and well-being matter; we’re here to help you seek justice.
