Insulin Pricing Under Fire: What It Means for Self-Funded Plans

Why It Matters

For years, the skyrocketing price of insulin has been at the forefront of America’s healthcare debate, and now it’s at the center of one of the most significant pharmaceutical pricing cases in history.

The ongoing Insulin Pricing Multidistrict Litigation (MDL No. 3080) consolidates lawsuits against the nation’s three largest insulin manufacturers and three major pharmacy benefit managers (PBMs), who together control roughly 80% of the U.S. prescription drug market.

The case centers on allegations of inflated insulin prices, an issue that could have major financial implications for self-funded employer health plans and hospitals that either manage self-insured plans or purchased insulin directly.

Allegations at a Glance

Plaintiffs allege that:

• Manufacturers set list prices artificially high, then paid rebates to PBMs to secure preferred formulary placement.

• PBMs, rather than negotiating lower prices, accepted inflated rebates and fees, creating incentives to raise prices instead of lowering them.

• These practices resulted in billions of dollars in overcharges to self-funded employers, insurers, and other payors that covered insulin purchases over the last fifteen years.

  • For example, the price of a 30-day supply of insulin rose from $271 in 2012 to $499 in 2021, an 184% increase. (Health Care Cost Institute)

  • U.S. insulin gross prices are more than nine times higher than in 33 other high-income nations. (RAND)

Key Milestones

• Early 2023: Multiple state Attorneys General file cases alleging inflated insulin pricing.

• August 2023: The MDL is established by the Judicial Panel on Multidistrict Litigation.

• Late 2023: The Court creates a separate track for Self-Funded Payer Plaintiffs.

• September 2024: The Federal Trade Commission (FTC) files a related lawsuit against PBMs, alleging unfair rebating practices.

Who May Be Impacted

• Self-funded employer health plans that covered insulin for employees and dependents.

• Healthcare Providers and Hospital Systems that run self‑insured health plans or paid for insulin directly.

• Third-party administrators (TPAs) and insurers managing prescription benefits for large plans.

If your organization purchased insulin directly from any of the defendants or provided coverage for insulin through a self-funded plan in the last fifteen years, you may be affected by the alleged overpricing practices.

MCAG’s Role

MCAG is actively monitoring the Insulin Pricing MDL and related cases. Our team specializes in:

• Identifying potential class eligibility.

• Managing the complex data required for claims.

• Preparing filings once any settlements or distributions become actionable.

Note

Some law firms and other organizations are contacting potential plaintiffs about joining this litigation directly. MCAG cannot provide legal advice, but we will continue to track the case and notify clients when class-action settlements become available for filing.