Four Pharmaceutical Giants Just Did The Lowest Effort Collusion Imaginable To Make Us Pay More For Medication.

Imagine walking into your local community clinic. It’s no fancy high-rise medical center, but it’ll suffice as a place of last resort for many. A place that serves the low-income and the underserved, running on a shoestring budget and a whole lot of heart.

For millions of Americans with diabetes, clinics like Mosaic Health in New York and Central Virginia Health Services are lifelines, providing access to medications they desperately need but can’t possibly afford.

For years, a federal program called 340B was the secret sauce that made this all possible. In exchange for access to the massive Medicare and Medicaid markets, pharmaceutical giants had to sell their drugs at a steep discount to these safety-net providers.

Those savings were then passed on to patients or reinvested to keep the clinic’s doors open. It worked. But in the summer of 2020, that promise was broken.

And it wasn’t broken by just one company. It was broken by a group of them, all at once.

Deadass not even kidding here. They literally all done it at the exact same time. How much more suspicious could you be? At least stagger that shit, goddamn….

A Suspiciously Synchronized Strike

The companies at the heart of this story are the titans of the diabetes drug world: Sanofi, Eli Lilly, Novo Nordisk, and AstraZeneca. They are supposed fierce “horizontal competitors” of the industry who dominate the multi-billion dollar markets for insulin and other critical diabetes medications. They fight for every last scrap of market share. Or at least, they’re supposed to.

In early 2020, these rivals suddenly found a common cause.

They teamed up, hiring the same high-powered lobbying firms to pressure the federal government to gut the 340B discount program they all disliked. They even coordinated their efforts through their shared industry association, PhRMA. But their lobbying blitz failed. The government didn’t bite.

So, they apparently decided to take matters into their own hands. What happened next was either an incredible coincidence or, as a federal lawsuit (you know where you can find it) alleges, a coordinated backroom deal.

The Ripple Effect

By choking off the 340B discounts, these companies ripped away the financial foundation of America’s safety-net clinics. The court filing (attached down below) puts it plainly: sales of discounted drugs to community pharmacies plummeted by a staggering 60% to 90% for these companies. That’s not just a number. That represents millions in lost savings that clinics relied on to serve their communities.

It meant clinics had to make impossible choices. Do they reduce staff? Cut back on services? Turn away patients who can no longer afford their insulin? The companies’ coordinated move created a healthcare crisis in slow motion, hitting the most vulnerable people the hardest.

A Feature, Not a Bug

When a handful of companies control the market for a life-saving drug, the normal rules of competition don’t apply. A federal appeals court looked at this situation and saw something that was, in their words, “plausible” enough to be a conspiracy.

Why would these rivals risk acting alone? They wouldn’t. The court documents suggest a lone wolf would have lost business as clinics flocked to competitors still offering discounts. But by acting together, they created “safety in numbers”. They could all raise prices in unison, and the clinics would have nowhere else to turn. They effectively cornered the market, together.

This is the predictable outcome of a system that prioritizes shareholder returns over public health. It’s a system where supposed competitors can hire the same lobbyists and sit on the same industry boards, all while claiming their identical, market-altering decisions are just a big misunderstanding.

A Glimmer of Accountability

For a moment, it looked like they would get away with it. A district court judge initially threw the clinics’ lawsuit out, siding with the drug companies and calling their story about a massive coincidence the “obvious alternate explanation”.

But in an unexpected reversal, the Second Circuit Court of Appeals brought the case back to life. They basically said that when something looks this suspicious, you don’t just shrug and dismiss it. You investigate. The court made it clear that at this early stage, the clinics’ story of a conspiracy was entirely plausible and deserved its day in court.

The fight is far from over however. But for the clinics and the patients who depend on them, it’s a crucial victory. It’s a sign that our current shitty system, however flawed, might still be able to hold the powerful to account. Maybe.

What Real Change Looks Like

This case pulls back the curtain on the pharmaceutical industry. It shows how easily the public good can be sacrificed for private profit. The fines and legal slaps on the wrist that often follow these cases are just the cost of doing business for multi-billion dollar corporations.

Meaningful change requires more. It requires robust government oversight that can’t be dismantled by a team of well-paid lobbyists. It requires breaking up the market dominance that allows a few companies to dictate the price of life and death. And most of all, it requires us to remember the promise we made—that in a country this wealthy, no one should have to choose between their health and their financial survival.

All factual claims in this article are sourced from the public court document Mosaic Health, Inc. v. Sanofi-Aventis U.S., LLC, No. 24-598 (2d Cir. 2025).