Florida Attorney General Sues Insulin Manufacturers, PBMs Over Alleged Pricing Scheme
Key Takeaways
- Florida filed a lawsuit against major insulin manufacturers, pharmacy benefits managers (PBMs), and rebate aggregators, alleging that rebate and formulary arrangements contributed to higher insulin prices.
- The state claims the arrangements favored higher-list-price products while limiting competition from lower-priced alternatives.
- Several defendants dispute Florida’s allegations and maintain that their pricing and business practices comply with applicable law.
Florida Attorney General James Uthmeier has filed a lawsuit against major insulin manufacturers, PBMs, and affiliated rebate aggregators, alleging that rebate and formulary arrangements contributed to inflated insulin and diabetes medication prices for Florida consumers.
The complaint, filed September 22, 2026, in Miami-Dade County Circuit Court, names insulin manufacturers Eli Lilly and Company, Novo Nordisk Inc, and Sanofi-Aventis US LLC, along with entities affiliated with CVS Caremark, Express Scripts, and OptumRx. Rebate aggregators Zinc Health Services, Ascent Health Services, and Emisar Pharma Services are also among the defendants.1-3
According to the complaint, the 3 manufacturers collectively control more than 90% of the global insulin supply by volume and revenue, while CVS Caremark, Express Scripts, and OptumRx process approximately 80% of prescription claims nationwide.1
Florida Alleges Rebates Influenced Formulary Placement
Florida alleges that insulin manufacturers and PBMs participated in commercial arrangements in which manufacturers provided rebates, fees, price-protection payments, and other remuneration in exchange for preferred or exclusive formulary placement and other conditions affecting access to competing products.1
The state does not allege that rebates or other manufacturer payments are inherently unlawful. Instead, the complaint challenges what it describes as a quid pro quo relationship between those payments and formulary placement or exclusionary conditions that allegedly disadvantaged competing products with lower list prices.1
According to the state, these arrangements created incentives favoring products with higher list prices and larger rebates rather than competition based on lower list prices. Florida also alleges that some agreements included product exclusions, patient-switching requirements, and bundled arrangements involving insulin and insulin-adjunct medications.1
The lawsuit encompasses multiple insulin products as well as insulin-adjunct medications, including certain glucagon-like peptide-1 receptor agonists. The complaint identifies January 1, 2011, through January 1, 2023, as the primary period at issue.1
Fierce Healthcare reported that the lawsuit cites testimony from an Eli Lilly executive indicating that approximately $210 of the $280 list price for a vial of Humalog (insulin lispro) was returned to PBMs through rebates in exchange for formulary placement, although the report noted that the timing of the testimony was unclear.2
State Claims Pricing Practices Harmed Florida Consumers
Florida alleges that the challenged arrangements suppressed price competition, limited access to lower-priced alternatives, and increased consumers’ out-of-pocket costs. The complaint also claims that economic incentives affecting formulary placement and patient cost sharing were not adequately disclosed.1
The state further alleges that certain insulin prices increased by more than 1000% during the period addressed in the complaint, with some products reaching approximately $350 per vial.1
“These companies told Florida families they were working to make insulin affordable,” Uthmeier said in a statement quoted by Fierce Healthcare. “Instead, they inflated the sticker price of a medicine people cannot live without and left Florida patients to pay it.”2
The complaint alleges violations of the Florida Deceptive and Unfair Trade Practices Act and the Florida Antitrust Act. Florida is seeking restitution, disgorgement, civil penalties, damages, attorneys’ fees and costs, and injunctive and other equitable relief.1
Manufacturers and PBMs Dispute Allegations
Several defendants have rejected the state’s allegations.
An Eli Lilly spokesperson told Bloomberg Law that the company has “led the way in making insulin more affordable” and noted that other states have settled similar litigation without monetary payments.3
CVS disputed allegations that it influences the prices manufacturers charge for their products and said it intends to defend itself against the lawsuit. Novo Nordisk also described the allegations against the company as meritless and said it plans to defend against the claims.3
Sanofi told Bloomberg Law that its pricing practices have complied with the law and that the company remains focused on helping patients obtain medicines at the lowest possible price.3
Implications for Pharmacy Stakeholders
For pharmacists and other pharmacy stakeholders, the Florida lawsuit places additional scrutiny on the relationship between manufacturer rebates, PBM formulary decisions, and the prices patients encounter at the pharmacy counter.
The complaint specifically challenges arrangements that Florida alleges rewarded higher-list-price medications while limiting commercially meaningful formulary access for lower-priced alternatives. It also raises questions about transparency surrounding the financial incentives that influence formulary placement, patient switching, and pharmacy reimbursement.
The allegations have not been adjudicated, and the defendants dispute the state’s claims. As the litigation proceeds, pharmacy stakeholders may continue to watch how the court evaluates Florida’s claims regarding manufacturer-PBM contracting, rebate structures, formulary competition, and consumer drug costs.
References
- Office of the Attorney General, State of Florida. Attorney General James Uthmeier takes legal action against insulin manufacturers and pharmacy benefit managers for pricing scheme driving up costs for Florida families. My Florida Legal. Published September 22, 2026. Accessed September 30, 2026. https://www.myfloridalegal.com/newsrelease/attorney-general-james-uthmeier-takes-legal-action-against-insulin-manufacturers-and
- Minemyer P. Florida AG sues PBMs, pharmas over rise in insulin prices. Fierce Healthcare. Published September 23, 2026. Accessed September 29, 2026. https://www.fiercehealthcare.com/payers/florida-ag-sues-pbms-pharmas-over-rise-insulin-prices
- Ebert A. Florida sues Lilly, Sanofi, CVS in insulin antitrust action. Bloomberg Law. Published September 22, 2026. Updated September 23, 2026. Accessed September 29, 2026. https://news.bloomberglaw.com/antitrust/florida-sues-eli-lilly-sanofi-cvs-in-insulin-antitrust-action
