CINCINNATI — A new lawsuit filed by Hamilton County accuses multiple drug manufacturers and pharmacy benefit managers of inflating the price of insulin and other diabetes medications.
The suit, filed by the Hamilton County Board of Commissioners with County Prosecutor Connie Pillich, claims an illegal pricing scheme between manufacturers Eli Lilly, Novo Nordisk and Sanofi and pharmacy benefits managers CVS Caremark, Express Scripts, and OptumRx resulted in excessively high insulin prices for the county’s employees and dependents.
“Insulin is a lifesaving medication that has been around for decades, yet families and employers are paying more than ever to access it,” Commission President Stephanie Summerow Dumas said in a release. “When drug companies and middlemen drive up costs, it hurts our employees, their families and ultimately taxpayers.”
The county says it provides health coverage to about 8,800 plan members. From 2023 to 2025, insulin-related costs for those members totaled around $13 million — a number the commission noted could go toward other projects or workforces.
WATCH: County leaders discuss the reasoning behind the lawsuit
Hamilton County sues drug manufacturers, pharmacy companies over price of insulin
“When Hamilton County is forced to overpay for prescription drugs, that is taxpayer money that could be going toward road repairs, first responders, or educational opportunities. … The health care system should protect our community, not drain resources from it, and we are taking action to ensure fair prices for lifesaving medications,” Commissioner Alicia Reece said.
Hamilton County is seeking financial compensation for both its health plan members and taxpayers — as well as a court order to stop the alleged scheme.
According to the Centers for Disease Control (CDC), 11.4% of adults in Hamilton County have diabetes. That’s nearly 100,000 people.
Of those, 70% of them need insulin to live. Without insurance, it could cost hundreds for a single vial.
“I’ve seen what the cost has jumped and what people have to make decisions, do I get the insulin or do I get the groceries?” Reece said.
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The move is similar to many other active lawsuits across the state and country. Ohio Attorney General Dave Yost sued Express Scripts and Prime Therapeutics in 2023 for illegally driving up drug prices. Express Scripts, CVS Caremark and OptumRx together control 96% of the global market for insulin.
We reached out to all six companies named in the lawsuit, asking for their response to the claims. You can read the responses we received below.
“While we will not comment on the specifics of the allegations, Sanofi’s pricing practices have always complied with the law and the company is committed to helping patients access the medicine they need at the lowest possible price. Following through on that commitment requires Sanofi to navigate a complex environment. Under the current system, savings negotiated by health insurance companies and PBMs through rebates are not consistently passed through to patients in the form of lower co-pays or coinsurance. As a result, patients’ out-of-pocket costs continue to rise while the average net price of our insulins declines. Sanofi believes that no one should struggle to pay for their insulin, regardless of their insurance status or income level, which is why we have a suite of innovative and patient-centric savings programs to help people reduce their prescription medicine costs.”
Sanofi
“Pharmaceutical companies alone are responsible for the prices they set in the marketplace for the products they manufacture. Nothing in our agreements prevents drug manufacturers from lowering the prices of their insulin products and we would welcome such an action. Allegations that we play any role in determining the prices charged by manufacturers for their products are false, and we intend to vigorously defend against this baseless suit.”
CVS Caremark
“In the only three cases where insulin pricing allegations have been put to their proof, the plaintiffs have either dropped their case, lost their motion to proceed as a class action, or settled for no money. These outcomes speak for themselves. Lilly has been working for years to reduce insulin out-of-pocket costs for people with diabetes, against the headwinds of those—like parties filing these lawsuits—that benefit from rebates and choose higher list-price medicines over lower-priced options. Lilly was the first company to cap what patients pay at $35 per month for all of our insulins, we cut insulin prices by 70%, and in 2024 the average monthly out-of-pocket cost for Lilly insulin was less than $15.”
Eli Lilly
“For many years, Optum Rx has aggressively and successfully negotiated with drug manufacturers and taken additional actions to lower prescription insulin costs for our health plan customers and their members, who now pay an average of less than $18 per month for insulin. PBMs, like Optum Rx, are the key counterweight to pharmaceutical companies’ otherwise unchecked monopoly power to set and raise drug prices.”
Optum Rx
Clinton Mora is a reporter for Trending Insurance News. He has previously worked for the Forbes. As a contributor to Trending Insurance News, Clinton covers emerging a wide range of property and casualty insurance related stories.