The plaintiffs say they're fighting for patients. They're less forthcoming about the fact that they've profited handsomely from the system they're now decrying. For years, these cities and states have insisted on a cut—if not all—of the rebates that these pharmacy benefit managers extract from drug makers when negotiating over whether and how to cover specific drugs.
The first claim does not withstand scrutiny. The price of insulin has been falling for years—and hardly constitutes a national emergency. A recent report from the drugmaker Lilly, for instance, reveals that the net price of the company's Humalog brand of insulinfrom $62 a vial in 2018 to just $26 last year. The company's biosimilar insulin, Lispro, had a net price of justThe lawsuits are on firmer ground in their claim that PBMs are driving up costs for patients.
These rebates and discounts don't make their way to patients. PBMs and the health plans that hire them hang onto them.