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A federal judge in New Jersey last week issued a batch of more than 30 rulings impacting ongoing lawsuits regarding the cost of insulin.
U.S. District Judge Brian Martinotti issued one ruling that rejects insulin manufacturers' motions to dismiss litigation, another, involving the state of Montana, allows plaintiffs to move ahead with conspiracy allegations against PBMs, and a third, involving the state of Illinois, lets Illinois move ahead with allegations that PBMs and insulin makers deceived insulin buyers and were unfair to insulin buyers.
Other rulings allow plaintiffs to move ahead with discovery against defendants such as Cigna's Evernorth unit, CVS Health and UnitedHealth.
The judge ruled on litigation involving employers with self-insured health plans that the employers cannot sue the insulin manufacturers over racketeering allegations but can move forward with common-law fraud claims and conspiracy claims against the manufacturers.
The parties could not immediately be reached for comment.
The history: Some people with diabetes use insulin to keep their blood sugar levels. While some generic versions cost less than $50 per month, many more popular versions cost more than $300 per month.
The plaintiffs in the suits argue that pharmaceutical manufacturers and PBMs have worked together to keep what payers pay for insulin much higher than in the rest of the world.
The plaintiffs began filing the suits in 2023. The federal courts consolidated pretrial discovery for the suits under Martinotti in 2023.
The litigation: The plaintiffs in the insulin price suits include self-insured employers, states angry about Medicaid prescription drug spending, and other "payers."
Related: Employers take fights with Big Pharma and PBMs over insulin price-gouging charges to one federal court
The list of defendants in the group of cases mentioned in the Montana ruling includes CVS's Caremark pharmacy benefit manager unit, UnitedHealth's OptumRx PBM, Cigna's Express Scripts unit, along with insulin makers such as Eli Lilly and Novo Nordisk.
The Illinois ruling lists those PBMs and manufacturers, as well as others.
The PBMs and manufacturers have argued that they have gone to great lengths to make insulin affordable for the patients.
One point of contention for Cigna is the nature of the relationship of its Evernorth unit with Express Scripts and whether Montana has jurisdiction to sue Evernorth.
The rulings: The judge does not look directly at the merits of the suits in the new opinions, but does look at whether, if the factual assertions are assumed to be true, the plaintiffs have raised substantial enough allegations to move forward.
In connection with efforts to dismiss some claims in the Illinois litigation, for example, the judge writes that the behavior Illinois describes in its complaint could be considered unfair.
"The state explicitly alleges that PBM defendants' involvement in the Insulin Pricing Scheme made insulin less affordable and therefore less available to diabetics who need this medication," the judge writes. "Construing the state's allegations in the light most favorable to the state, the court finds that there is a substantial injury to consumers by stifling competition, raising prices, and making insulin more unavailable to consumers, causing them to turn to alternative and dangerous measures."
In the Montana ruling involving Montana's ability to sue Evernorth, the judge writes that Montana has shown that discovery "might well demonstrate facts sufficient to constitute a basis for jurisdiction" over Evernorth.
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