California sued the largest insulin makers and PBMs, alleging that they drove up the cost of the drug through unlawful, unfair and deceptive business practices in violation of Cal. Bus & Prof. Code 17200, et. seq. The three manufacturers named in the lawsuit produce over 90% of the global insulin supply and the three PBMs administer pharmacy benefits for roughly 80% of prescription claims managed. The lawsuit argues that because competition is highly limited in both their markets, these six companies are able to keep aggressively hiking the list price of insulin. The suit also alleges that the defendants artificially inflated the list prices of analog insulin, and maintained an artificially inflated net price of analog insulin, in a way that harms consumers without a sufficient offsetting benefit to those consumers; artificially inflated the list prices of analog insulin to, and maintained an artificially inflated net price of insulin at, unconscionable levels; used secret rebates for analog insulin in a way that harmed consumers and did not benefit competition; facilitated explicit or tacit collusion through facilitating practices, including the exchange or disclosure of competitively sensitive information. The suit also claimed unjust enrichment by the defendants. The state sought injunctive relief, civil penalties, restitution and attorneys fees. The defendants removed the case to federal court and the court remanded it.  The defendants appealed the remand to the Ninth Circuit.