The global insulin market is dominated by three companies: Eli Lilly, the French company Sanofi and the Danish firm Novo Nordisk. All three have raised list prices to similar levels. According to IBM Watson Health data, Sanofi's popular insulin brand Lantus was $35 a vial when it was introduced in 2001; it's now $270. Novo Nordisk's Novolog was priced at $40 in 2001, and as of July 2018, it's $289. The companies appear to have increased [prices] in lockstep over a number of years, prompting allegations of price fixing. All three companies denied these charges. (In 2010, Mexico fined Eli Lilly and three Mexican companies for price collusion on insulin, an allegation Eli Lilly also denied.) In the United States, a federal prosecutor and at least five state attorneys general are currently investigating the companies' pricing practices. There is also another, less known corporate entity in the mix: pharmacy benefit managers (PBMs), which include Express Scripts, OptumRx and CVS Health; all are now named in lawsuits on high insulin prices. These corporate entities are powerful special interests. In 2017, the pharmaceutical and health product industry ... spent nearly $280 million on lobbying, the biggest spender by far of 20 top industries, according to the Center for Responsive Politics. The industry also has a revolving door to government. Alex Azar, the head of the Department of Health and Human Services, was the president of Eli Lilly's U.S. division until 2017.