Self-insured cities, counties, states, government agencies, and private employers have spent billions on overpriced insulin. If your organization paid inflated costs through a PBM or third-party administrator, you may be eligible to recover losses from the manufacturers and PBMs involved in price fixing and other unlawful practices.
Any self-insured entity has the right to take legal action against these companies. Our insulin overpricing lawsuit lawyers represent public and private organizations seeking to hold drug manufacturers and PBMs accountable for manipulating insulin prices through inflated list prices and hidden rebate structures.
GED Lawyers has been in practice since 1995 and has recovered over $26 million for clients. Our product liability lawyers are prepared to evaluate your organization’s claim and pursue compensation for unjustified prescription costs.
What Entities Can File an Insulin Overpricing Lawsuit?
Self-insured organizations are uniquely positioned to respond to artificially inflated insulin prices with legal action. This is because they self-fund employee health plans and directly absorb prescription medication costs, including insulin.
If your organization covered insulin costs for employees, retirees, or beneficiaries at any time between 2010 and 2023, you may qualify to participate in legal action seeking financial recovery. This includes situations where costs were reimbursed directly, through a third-party administrator, or using a pharmacy benefit agreement.
Eligible entities include:
- Local governments such as cities, counties, and school districts
- State agencies managing health plans for public employees
- Federal departments or public programs that are self-funded
- Private-sector employers with fully or partially self-insured health plans
- Labor unions that operate self-funded benefit plans for members
- Nonprofit organizations with self-insured health coverage
These entities have the legal standing to pursue compensation for excessive insulin payments linked to pricing coordination between drug manufacturers and pharmacy benefit managers. Current lawsuits are structured to allow eligible organizations to join as part of a broader legal effort, which may include class action or multidistrict litigation.
Participation in this type of case gives your organization the opportunity to recover losses without managing the litigation process independently. GED Lawyers is prepared to evaluate your eligibility and support your next steps.
Deadlines to file may apply under federal or state law, depending on your organization’s location and insurance structure, so early legal review is critical to preserve your claim.
Insulin Pricing Litigation Context
Over the last 10-plus years, U.S. spending on insulin has increased from $8 billion in 2012 to more than $22 billion in 2022, according to the American Diabetes Association (ADA). The ADA and other advocacy groups have called for greater accountability, citing price increases that far exceed production costs.
The insulin market is dominated by three manufacturers: Eli Lilly, Novo Nordisk, and Sanofi. These companies control approximately 96% of the global insulin supply.
In the United States, three pharmacy benefit managers control more than 80% of prescription drug transactions. Those PBMs are CVS Caremark, Express Scripts, and OptumRx. This level of market concentration has raised concerns about anti-competitive conduct and a lack of transparency.
In August 2023, insulin pricing lawsuits were consolidated in federal court. GED Lawyers is reviewing claims on behalf of self-funded entities harmed by coordinated pricing practices involving insulin manufacturers and PBMs. These claims focus on two main allegations:
- Rebate-driven formulary placement: PBMs required large rebates in exchange for placing insulin products on preferred drug lists. This practice encouraged manufacturers to raise list prices.
- Price fixing: Manufacturers allegedly coordinated price increases to maintain market share and avoid price-based competition.
These actions have significantly increased costs for self-funded health plans.
The Role of PBMs in Insulin Pricing
PBMs played a key role in the pricing structures at the center of the insulin litigation. These companies negotiate with drug manufacturers and influence which medications are covered under health plans.
While PBMs are expected to lower costs for plan sponsors, their rebate arrangements and formulary practices are now being scrutinized for contributing to inflated insulin prices.
Instead of lowering costs, PBMs allegedly made agreements with insulin manufacturers that linked preferred drug list placement to high rebate payments. These undisclosed arrangements encouraged manufacturers to raise list prices, shifting the financial burden to self-funded plans.
Regulatory agencies, including the Federal Trade Commission (FTC), have launched investigations into PBMs for potential anticompetitive conduct. Lawsuits now name major PBMs alongside manufacturers, citing their shared role in enabling and sustaining excessive insulin costs.
If your organization relied on a PBM to manage pharmacy benefits, your plan spending may have been affected. Our legal team can review your records and determine whether your organization may be eligible for compensation.
Why an Insulin Overpricing Lawsuit Matters
Self-insured organizations across the country have absorbed excessive prescription drug costs due to alleged unlawful pricing conduct by insulin manufacturers and pharmacy benefit managers. These rising costs were not the result of increased production expenses or legitimate market forces but are believed to stem from coordinated strategies that placed the financial burden on payers.
Legal action may be warranted if your organization has experienced:
- Price fixing and collusion: Coordinated efforts by drug manufacturers and PBMs may violate state and federal antitrust laws.
- Unjust enrichment: Overpayments made for insulin may have unfairly benefited parties who manipulated the pricing system.
- Deceptive practices: Misleading information about insulin pricing and rebate structures may have prevented your organization from making informed decisions about coverage and formulary design.
The consequences of these practices extend over multiple years. If your organization operates a self-funded health plan, you may have overpaid for insulin across several fiscal cycles. These inflated costs may have affected your budget, reduced resources for other programs, or increased expenses for employees and members.
Legal action gives your organization the opportunity to recover those losses and hold the companies involved accountable.
Damages Your Organization May Recover
Insulin price inflation has placed a long-term financial burden on self-insured entities. If your organization paid inflated prices for insulin and related medications, you may have a legal right to recover those losses. GED Lawyers is prepared to take on this work for you, managing the full legal process from case evaluation to potential litigation or settlement.
Recoverable damages may include:
- Direct overpayments for insulin: We will review your organization’s pharmacy claims data and purchasing records to identify and calculate the excess amounts paid due to inflated list prices and rebate structures.
- Costs tied to formulary changes or coverage restrictions: Our legal team will evaluate how pricing schemes forced changes to your benefit structure, limited access to specific medications, or led to cost-sharing increases that financially impacted your plan.
- Broader economic losses and harm: We can help your organization pursue compensation for the downstream financial effects of deceptive pricing, such as higher insurance premiums, budgetary strain, or redirected funding from public programs.
We understand the financial and operational challenges these inflated costs create. Our attorneys will build a case based on your specific records and documentation, ensuring that your claim is supported by clear, compelling evidence.
GED Lawyers is currently investigating claims on behalf of public and private entities with significant losses. We will handle the legal work, manage all discovery and filings, and pursue maximum compensation on your behalf.
How GED Lawyers Supports Self-Insured Plaintiffs
GED Lawyers is committed to helping self-insured entities pursue claims against insulin manufacturers and PBMs that contributed to excessive healthcare costs. Our firm is equipped to handle complex, large-scale litigation and supports clients throughout the entire legal process.
Our attorneys will take the lead on every step of your claim, including:
- Conducting a detailed analysis of your organization’s pharmacy claims data and benefit plan structure
- Reviewing PBM agreements to identify pricing terms, rebate arrangements, and administrative fees that contributed to inflated costs
- Coordinating with economic and healthcare consultants to quantify damages across multiple plan years
- Drafting, filing, and serving all legal documents in compliance with applicable state and federal requirements
- Representing your organization in case management conferences, motion practice, and settlement negotiations
We understand the demands of operating a public agency or private company with self-funded insurance. Our team takes on the legal burden so your internal teams do not have to divert time or resources. You stay informed throughout the process while we manage deadlines, documentation, and communications with opposing counsel.
Our work is performed on a contingency basis, so there are no upfront costs. Your organization pays nothing unless we recover funds on your behalf.
Start Your Insulin Claim Today
GED Lawyers is reviewing claims from self-insured entities affected by inflated insulin pricing. If your organization operates a self-funded health plan and incurred excessive costs, our legal team can assess your eligibility and recommend the appropriate legal strategy.
We will review your plan structure, pharmacy benefit data, and historical payments to determine whether you have a viable claim. If you choose to proceed, we will handle all required filings and manage the process on your behalf.
Time limits may apply. Early legal review helps preserve your right to seek recovery.
Contact GED Lawyers to start your evaluation. We represent municipalities, public agencies, and private employers seeking to recover insulin-related losses.
