Pharmacist George Tadross takes care of a customer at MAC Pharmacy in Cleveland in May 2024. Insurance companies, and the pharmacy benefit management companies that handle prescriptions for them, ...

Insulin costs have tripled over the past decade, with most of the increase going to middlemen and corporations.

At least 36 states — including Maryland, where Yermal lives — have laws that are supposed to limit insurers’ use of step therapy. But most only apply in certain cases, and enforcement has been spotty.

Cassidy Yermal, 32, began experiencing debilitating migraines when she was 17 years old. As a teenager growing up in northeastern Pennsylvania, she saw numerous neurologists and tried a variety of ...