Embattled Utah attorney general answers allegations of misconduct at announcement of insulin lawsuit

Sean Reyes defended his travel and expressed confidence in the outcome of a legislative audit.

(Mark Eddington | The Salt Lake Tribune) Utah Attorney General Sean Reyes holds a news conference in St. George, Thursday, Nov. 16, 2023, announcing a lawsuit against insulin manufacturers.

St. George • The Utah Attorney General’s office and Utah Division of Consumer Protection filed suit today against the nation’s leading insulin manufacturers and pharmacy benefits managers (PBMs), accusing them of conspiring to keep insulin prices artificially high at the expense of diabetics.

Speaking at a press conference at the Dixie Convention Center in St. George, embattled Attorney General Sean Reyes said the lawsuit filed in Third District Court seeks a permanent injunction that would prevent the manufacturers and PBMs from further violating the Utah Consumer Sales Practices Act. It also seeks relief to redress victims for injury and damage caused by the “illegal pricing scheme.”

Eli Lilly, Novo Nordisk, and Sanofi, which Reyes said manufacture 99 percent of the nation’s insulin and had combined revenues in 2019 totaling nearly $23 billion, are named in the suit. So are pharmacy benefits managers CVS Caremark, Express Scripts and OptumRx, which Reyes accused of colluding with manufacturers to raise costs to exorbitant levels.

Reyes noted that nearly 8% of Utahns — about 200,000 residents — have diabetes and another 700,000 have prediabetes. The estimated yearly cost of treating diabetics in Utah is $1.7 billion, which breaks down to one in every four dollars spent on health care in the state.

Meanwhile, the cost of insulin has skyrocketed. For example, the cost of Humalog insulin has jumped over 1500%, according to the U.S. Bureau of Labor Statistics Reyes cited during his presentation. The insulin vial that cost $20 in the late 1990s, he added, now costs between $350 and $700, even though the manufacturing cost is “as low as $2 per vial.”

“Because of the artificially inflated price of insulin medication,” Reyes said, “diabetes patients in Utah are taking desperate measures, including rationing insulin, starving themselves to reduce the need for insulin, taking expired insulin or insulin that hasn’t been stored properly… These measures can lead to serious health complications, including heart disease, kidney disease and failure, blindness and hearing loss, nerve pain and damage, foot problems, stroke and even death.”

Most questions directed toward the Attorney General, though, had little to do with the lawsuit. Rather, Reyes fielded questions about his extensive international travel over the past several years to luxury resorts in Portugal and Cabo and Acapulco in Mexico, among others. He was queried about why he won’t make his work schedule public.

He also was asked about the legislative audit he is facing over his management of the office and his close relationship with anti-sex trafficking activist Tim Ballard, the former head of Operation Underground Railroad who is facing a criminal investigation and a civil lawsuit involving allegations of sexual assault and misconduct.

Reyes defended his extensive international travel, saying many crimes — human trafficking and the opioid epidemic, for example — are transnational. He said Utah has hosted prosecutors, justice ministers and other leaders to combat such problems, and he has traveled to other countries to “train their people” or to “share information.”

He said the contacts he has made during his trips to Mexico have been especially beneficial, enabling him to better assist Utahns who were stuck or in trouble in that country and to work on issues with the Mexican government when “cartels are running their drugs up into our states …”

As for his refusal to hand over his work calendar, he said the matter is in litigation and added his schedule is not a public record. While he won’t divulge his day-to-day routine, he said the upcoming audit should “show that we achieve incredible results for the state of Utah.”

Reyes expressed confidence in the outcome of the audit.

“I think it’ll show … that we have an incredible office that functions really efficiently,” he said. “We have some of the best public servants — not just in Utah but all of America.

“We hope that the audit might be able to highlight some areas where we can be even more efficient,” he added. “But if people are looking for something, there is no smoking gun in this audit because there were no shots [fired].”

Another issue is the timing of the lawsuit, which comes as Reyes is under close scrutiny and amid assertions, including from The Salt Lake Tribune’s editorial board, that the Attorney General is an “embarrassment” who should resign or refuse to run for reelection.

Utah Solicitor General Melissa Holyoak defended the timing, saying the office looked at the legal action taken by other states against insulin manufacturers over the past year, conducted an investigation and hired outside counsel before filing its own complaint that “sets forth all the allegations.”

Utah’s age-adjusted diabetes rate is relatively low, about 8.4% compared to the national rate of 10.3%. Nonetheless, Grand County Commissioner Mike McCurdy, who is diabetic, defended the suit at the press conference.

“Does my one number not matter …?” he asked, noting his insurance does not cover the full cost of the insulin he needs. “I am just one but I know of many community members in Grand County who are Type 1 … insulin-dependent diabetics and we are all fighting the same fight.”

San Juan County Commissioners Silvia Stubbs and Bruce Adams also spoke in support of the legal complaint. Stubbs, who is Navajo, said she has a friend who is paying $3,000 each month for insulin. Adams echoed Stubbs’ concerns about cost.

“In San Juan County, 20% of our population uses insulin — not because they want to but because they have to. We are the poorest county in the state of Utah. So you are asking the poorest people in the state … to pay the highest price for insulin.”