The resolution, lodged in a New Jersey federal district court, mandates Lilly to limit its insulin’s out-of-pocket expenses to $35 per month for a period of four years.
The agreement was reached three months subsequent to the company’s declaration of slashing its Type 1 diabetes treatment price to the same figure, aiming to facilitate better access to Lilly’s insulin and assisting Americans struggling with the intricacies of the healthcare system.
The backdrop of Lilly’s initial price reduction was a plea by President Joe Biden during his State of the Union address, urging Congress to cap insulin costs for all patients at $35 per month. The Inflation Reduction Act had already set a similar limit for Medicare patients.
The lawsuit was launched in 2017 against insulin producers Lilly, Novo Nordisk, and Sanofi. The plaintiffs accused these companies of engaging in a price-escalation battle, increasing their medications’ list prices while the “actual” price to pharmacy benefit managers stayed steady or even dropped in some instances. This was supposedly done to exploit the widening gap between public and private prices, securing a favourable formulary placement, as alleged by the lawsuit.
These practices, the lawsuit contends, burdened patients who pay out-of-pocket expenses based on a drug’s list price. The cost of insulins, which used to be $25 per prescription, was hiked to $450, according to the class-action suit. Such “lockstep” increases were characterized as “staggering and inexplicable”.
Shortly after Lilly limited its insulin’s out-of-pocket costs, Novo Nordisk and Sanofi followed suit. However, these firms are yet to reach a settlement in this case.
Lawyers from two law firms posit that Lilly’s settlement will be worth $500 million to consumers over the four years of capped prices. Qualifying claimants can obtain cash settlements based on their Lilly insulin purchases and a formula agreed upon by the parties.
Steve Berman, managing partner of Hagens Berman, applauded the settlement, stating, “This agreement will provide immense, proactive relief, particularly for those underinsured or shouldering co-insurance—those most urgently needing help,” in a press release.”