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In response to strained budgets, a growing number of state and local governments across the U.S. are suing insulin makers and pharmacy benefit managers over claims the companies conspired to illegally drive up prices.

In recent weeks, state officials in Utah and Arizona, and municipalities in New York, Virginia, Maryland, and Ohio have filed lawsuits alleging that the companies artificially drove up the cost of insulin, making the medication unaffordable for countless residents who have diabetes and causing the governments to overpay for the medication.

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Such claims are hardly new. Over the past few years, various lawsuits, some of which were also filed by consumers, alleged that Eli Lilly, Sanofi, and Novo Nordisk conspired with the nation’s largest pharmacy benefit managers — Express Scripts, OptumRx, and CVS Caremark — to profit from a complicated scheme involving lockstep pricing, favorable insurance coverage, and secret rebate fees.

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