Pennsylvania Attorney General Dave Sunday has sued several drugmakers and pharmacy benefit managers, alleging they conspired to drive up insulin prices and left people with diabetes facing unaffordable costs. The lawsuit, filed Friday, claims the companies raised insulin prices by more than 1,000% beginning in the mid-2000s, even though the drugs cost less than $2 to make. Products that had cost consumers about $20 allegedly came to carry prices of $300 to $700 or more, the state says. The complaint alleges manufacturers shared part of their profits with pharmacy benefit managers, or PBMs, which administer prescription-drug benefits for health insurers. It further claims that, beginning around 2012, PBMs excluded competing insulin products from some plans to increase their own earnings. The state says the alleged conduct affected 1.3 million Pennsylvanians with diabetes and 3.5 million with prediabetes. The complaint says some people were driven to ration insulin or restrict food to manage their blood sugar. It argues that inflated list prices can affect what patients and health plans pay, even when the actual amount varies by coverage and other factors. Eli Lilly, Sanofi, Novo Nordisk, CVS Caremark and OptumRx are among the companies named, along with 14 others. The allegations have not been proven in court. Sunday is asking for restitution for affected residents and an injunction under Pennsylvania’s Unfair Trade Practices and Consumer Protection Law. The lawsuit also seeks civil penalties of up to $1,000 for each violation, or $3,000 when a violation involves a person age 60 or older. The case follows a 2024 lawsuit by Philadelphia District Attorney Larry Krasner against a largely similar group of manufacturers and PBMs. That year, insulin makers including Eli Lilly and Novo Nordisk announced price cuts amid public criticism and federal pressure. Since 2023, Medicare has capped insulin costs at $35 per month for covered seniors; that cap does not apply to everyone who needs the medication.