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The California attorney general has filed a lawsuit accusing several drugmakers and pharmacy benefit managers of conspiring to set prices for insulin, joining a growing list of states that have taken such a step as more and more Americans struggle to afford the life-savings diabetes treatment.

The lawsuit alleges that the companies “unconscionably, deceptively, misleadingly, and artificially” drove up the cost of insulin, making the medication unaffordable for many of the 3 million state residents with diabetes and causing the state government to overpay for the medication. The lawsuit also maintained the pricing disproportionately harms low-income communities.

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Specifically, the state charged that the manufacturers — Eli Lilly, Novo Nordisk, and Sanofi — worked in “lockstep” to “artificially” raise prices even as production costs plummeted. And the state also alleged the largest pharmacy benefit managers in the U.S. — Express Scripts, CVS Caremark and OptumRx — profited by receiving “secret” rebates from the manufacturers.

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