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Massachusetts is the latest state going after insulin makers and the intermediaries officials accuse of price gouging.

Why it matters: Diabetes patients are often paying hundreds of dollars a month or more for life-saving medicine when the costs of production remain largely unchanged, Attorney General Andrea Campbell's lawsuit says.

• Those price increases can cause diabetics to forego insulin shots or find workarounds that endanger them, the lawsuit argues.

Driving the news: Campbell's office filed a lawsuit this week in Suffolk Superior Court against drugmakers and the middlemen, known as pharmacy benefit managers, accusing them of defrauding diabetes patients through an insulin pricing scheme.

• The lawsuit names drugmakers Eli Lilly, Novo Nordisk and Sanofi, as well as PBMs Optum Rx, Express Scripts, CVS Caremark and affiliated companies.

The other side: CVS Caremark told Axios that drugmakers "alone are responsible" for setting their products' prices. The company also said its ReducedRx program offers insulin for $25.

• Sanofi said the average net price of its insulins has declined but that savings negotiated by PBMs and insurers through rebates "are not consistently passed through to patients."
• Other companies named in the suit did not respond to Axios' requests for comment.

By the numbers: One 2018 study suggests making a year's supply of insulin costs anywhere from $48-$134 per person.

• Massachusetts has some 500,000 diabetes patients and 1.8 million pre-diabetic patients, many of whom rely on insulin and are paying hundreds monthly for the list prices, the lawsuit says.

The big picture: New York and Minnesota have successfully gotten drugmakers to cap their prices to $35 a month in legal settlements.

• The Federal Trade Commission in September sued three major PBMs and affiliated companies, accusing them of engaging in anticompetitive and unfair rebating practices that inflate insulin prices.
• Express Scripts previously sued the FTC over a July report purporting to show how PBMs manipulate the market at the expense of patients.

Between the lines: Massachusetts recently enacted a law that caps name-brand drugs for certain illnesses, including diabetes, at $25 a month, among other changes.

• But Campbell's lawsuit targets what she described as the source of the problem: the pricing agreements secretly agreed upon by drugmakers and PBMs.

Keep reading: Inside the lawsuit

Gov. Healey yesterday asked lawmakers to limit emergency shelter to Massachusetts residents, among other major changes to the state's right-to-shelter law.

Why it matters: The emergency shelter system has come under scrutiny in recent years for expanding to house thousands of migrants fleeing their native countries, which Republicans and some Democrats say leaves residents in need without resources.

Between the lines: Healey's letter comes after months of mounting GOP scrutiny over shelter spending and violence at the state-run facilities, including a news conference Tuesday hosted by GOP lawmakers.

• Shelter spending ballooned to $1 billion in fiscal 2024 and will likely cost the same this fiscal year.
• Republican lawmakers' criticisms grew louder after records showed 1,000 serious incidents, including more than a dozen sex offenses, at the shelters.

Driving the news: Healey asked lawmakers in a letter Wednesday to consider a list of reforms, perhaps the biggest being eliminating the law's presumed eligibility standard.

• The 1982 law requires that families self-attest to meeting the state's eligibility requirements without providing documentation up front.

Other proposed changes include:

• Running background checks on adult applicants. The state currently only makes applicants disclose criminal convictions if they're relevant to a recent eviction.
• Considering applicants who had evictions or inhabitable homes only if those homes were in Massachusetts.
• Requiring that all applicants show proof of citizenship or lawful permanent residency. There's an exception for mixed-status families if a child is a citizen or lawful permanent resident.

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