Virginia’s Attorney General, Jason Miyares, announced Tuesday his office is investigating whether insulin manufacturers and pharmacy benefit managers (PBMs) have artificially inflated prices while “deceiving consumers”. His office said in a press release the probe could uncover violations of the state’s Consumer Protection Act.
For many Virginians, insulin is not optional, but the cost keeps rising. According to the American Diabetes Association, more than 10% of Virginians live with diabetes and a national 2023 study found 1 in 5 U.S. adults under 65, who use insulin, reported rationing it because of the price.
“Since 2005 when I was diagnosed, on a consistent basis, I’ve seen an increase in out-of-pocket costs,” said Thomas Eddy, who has Type 2 diabetes. “$400 is quite a hump. The alternative to that would be poking my finger three, four times a day to check my glucose.”
PBMs act as middlemen between drugmakers, insurance companies, and pharmacies, negotiating rebates and discounts. But critics argue that the savings don’t always make it to patients.
“It seems like the insurance companies are paying for less and less,” Eddy said.
A federal law passed in 2022 caps insulin copays at $35 a month, but only for seniors on Medicare. Local pharmacists say patients paying cash mistakenly think the cap applies to them as well, only to be disappointed.
“So you had patients who were either not Medicare eligible or didn’t have a Part D plan,” said local pharmacist, Kayla Lucas. “A lot of them were confused when they got their co-pays. They were like, I thought this was a $35 copay. I’m like no, you’re not a Medicare patient, that’s only for Medicare.”
Miyares said in the press release his office “will not hesitate to act” if companies are found to have violated state law. He works alongside other states who are also pushing for broader reforms aimed at holding PBMs accountable, lowering costs, and protecting independent pharmacies.