Amid continuing calls for broader caps on insulin prices – including a push from President Joe Biden – California’s attorney general is taking the fight to the courtroom.

Attorney general Rob Bonta last month sued three drug makers and three pharmacy benefit managers, alleging that they have conspired to drive up the cost of the drug, which is widely used by people with diabetes, a group that represents more than 10% of California’s population.

Five of the drug makers and PBMs involved – Eli Lilly, Novo Nordisk, Sanofi, CVS Caremark and Optum Rx – rejected the lawsuit’s claims or declined to comment. Efforts to reach Express Scripts were not successful.

The suit comes amid the rollout this year of a $35 cap on co-pays for insulin for people on Medicare. In addition, more than 20 states have enacted some kind of price cap on insulin, devices and diabetes supplies, according to the American Diabetes Association and The Pew Charitable Trusts. California is not among them.

The state’s lawsuit takes aim at what it contends are practices that drive up the cost of insulin in violation of California law.

“Insulin is a necessary drug that millions of Americans rely upon for their health, not a luxury good,” Bonta said in a statement. “With today’s lawsuit, we’re fighting back against drug companies and PBMs that unacceptably and artificially inflate the cost of life-saving medication at the expense of vulnerable patients.”

Insulin prices have risen over the last two decades, studies show. However, the overall retail price has fallen about 5% since 2019, largely due to FDA approvals of generics and biosimilars, according to GoodRx, a digital platform that helps people compare the cost of prescription drugs.

In responding to the California lawsuit, drug companies and PBMs portrayed themselves as part of the solution to lower prices.

In an email, an Eli Lilly spokesperson argued that anyone with diabetes is eligible to buy the company’s insulin for $35 per month, even if they are uninsured. The company also noted that it slashed by 70% the price of its non-branded insulin compared to its branded counterpart, Humalog, returning the list price to 2008 levels.

A Novo Nordisk spokesperson said in an email that roughly 63,000 U.S. patients receive free insulin from the company and another 1.4 million get assistance. The spokesperson also touted a company program that provides a free 30-day supply of insulin, as well as other programs designed to make insulin affordable.

Optum Rx, meanwhile, offers a 30-day supply of commonly used insulins to uninsured people with diabetes, company spokesperson Isaac Sorenson said in an email.

“Optum Rx welcomes the opportunity to show the California Office of the Attorney General, just as it has with other states’ attorneys general, how we work every day to provide people with access to affordable drugs, including insulin,” Sorenson added.

By contrast, CVS Caremark’s stance seems to be to blame it all on pharma companies. A spokesperson said in a statement that pharma companies alone set drug prices.

“Nothing in our agreements prevents drug manufacturers from lowering the prices of their insulin products and we would welcome such action,” said Phillip Blando in a statement. “Allegations that we play any role in determining the prices charged by manufacturers are false.”

The courtroom is not the only venue where elected officials are seeking tackling insulin costs.

The Inflation Reduction Act capped the price of insulin at $35 per month starting in January but only for people on Medicare. GOP lawmakers blocked the effort to impose the cap on private insurers, according to The Washington Post.

In his state of the union speech Feb. 7, President Joe Biden urged lawmakers to pass an expanded cap. He noted that millions of Americans are not on Medicare, including about 200,000 young people with type 1 diabetes.

“Let’s finish the job this time,” Biden said, echoing a refrain that punctuated his address on Tuesday.

Photo: Maksim Luzgin, Getty Images