In the world of medicine, the cost of living with diabetes is skyrocketing, and it's not just because of the drugs themselves. A recent lawsuit filed by the Federal Trade Commission (FTC) against three major pharmacy benefit managers (PBMs) sheds light on a more sinister force driving up insulin prices: the middlemen. UnitedHealth's Optum Rx, CVS Health's Caremark, and Cigna's Express Scripts are being accused of using shady practices to boost their profits, leaving millions of Americans struggling to afford life-saving medication.

These PBMs, which control nearly 80% of the nation's prescriptions, have created a "perverse" rebate system, prioritizing high rebates from drugmakers over lower-cost alternatives. This means that patients are often forced to choose between rationing their medication or going bankrupt trying to pay for it.

The FTC's complaint highlights the Big Three PBMs' exploitative conduct, which has led to inflated list prices for insulin. For example, Eli Lilly's Humalog insulin has increased in price by over 1,200% since 1999. The agency claims that these middlemen are more concerned with padding their own pockets than with providing affordable care to patients.

The impact of high insulin prices is devastating. Roughly eight million Americans rely on this life-saving medication to survive, and many have been forced to ration their treatment due to the high cost. The situation is especially dire for those without access to affordable insurance or government-subsidized programs.

President Joe Biden's Inflation Reduction Act has taken a step towards addressing this issue by capping insulin prices for Medicare beneficiaries at $35 per month. However, this policy doesn't extend to patients with private insurance, leaving a significant gap in coverage.

The Biden administration and Congress have recently ramped up pressure on PBMs, seeking to increase transparency into their operations and restore healthy competition to drive down drug prices for consumers. The FTC's lawsuit marks an important step in this direction, and it remains to be seen whether the middlemen will be held accountable for their actions.

HUMALOG

Insulin Price Fixing: The Unseen Hand Behind Diabetes