Florida AG sues Eli Lilly, Novo Nordisk, Sanofi and three PBMs over insulin list prices
Key Insights
Florida Attorney General James Uthmeier filed suit against Eli Lilly, Novo Nordisk and Sanofi plus pharmacy benefit managers CVS Caremark (search), Express Scripts (search) and OptumRx (search) over insulin pricing.
The complaint alleges manufacturers raised published list prices and paid rebates to PBMs for preferred formulary placement, leaving patients tied to list prices paying more.
The state brings two counts under Florida's Deceptive and Unfair Trade Practices Act and one under the Florida Antitrust Act, seeking injunction, restitution, disgorgement, damages and penalties.
Florida Attorney General James Uthmeier has sued the three companies that supply most of the world's insulin and the three largest pharmacy benefit managers, alleging the companies inflated prices paid by Florida patients. The lawsuit, announced in a statement from Uthmeier's office on Sept. 22, names Eli Lilly, Novo Nordisk and Sanofi, along with CVS Caremark (search), Express Scripts (search) and OptumRx (search). The claims are allegations, and no court has ruled on them.
The complaint was filed in Florida's Eleventh Judicial Circuit, which covers Miami-Dade County. It also names three rebate aggregators, Zinc (search), Ascent (search) and Emisar (search), and covers GLP-1 and combination drugs including Ozempic, Trulicity, Victoza and Soliqua. In total the lawsuit names nine companies, including drugmaker Eli Lilly and CVS Caremark (search), which helps manage prescription coverage for insurance plans.
Uthmeier framed the case around patient access. "Insulin can be, for many people, the difference between life and death," he said. "People should not have to live in fear over the price of a life and death drug." He said the companies "inflated the sticker price of a medicine people cannot live without and left Florida patients to pay it."
The allegations at the center of the complaint
The state alleges that the drugmakers raised published list prices for insulin and related diabetes (search) drugs, then paid rebates and fees to the pharmacy benefit managers in exchange for preferred placement on the lists of drugs health plans cover. According to the state, both sides profited as sticker prices rose.
The complaint cites testimony from a Lilly executive that about $210 of every $280 Humalog vial, roughly 75%, went back to pharmacy benefit managers as rebates and discounts. Fierce Healthcare noted it was not immediately clear how recent that testimony was.
The case rests on the gap between two prices. The list price is the published sticker price, while the net price is what a manufacturer keeps after rebates. The state argues that a system built on rebates rewarded higher list prices and that patients whose costs are tied to the list price absorbed the difference.
Florida brings two counts under the state's Deceptive and Unfair Trade Practices Act and one under the Florida Antitrust Act. It seeks a permanent injunction, restitution, disgorgement, damages and civil penalties. Uthmeier is asking a court to stop the practices outlined in the lawsuit and provide financial relief to Florida patients.
Who pays the list price
The state says about 2.3 million Florida adults, roughly 1 in 10, have diagnosed diabetes (search). Not all of them use insulin, but the complaint centers on a cost problem that can reach households across the state. People who are uninsured, still in a deductible, or paying coinsurance, a percentage of the price, are often charged based on the list price.
According to the American Diabetes (search) Association, 2025 data shows about 2.2 million adult Floridians have diagnosed diabetes. Dr. Faith Maignan, an assistant professor at Florida A&M University's College of Pharmacy, said the harm from uncontrolled diabetes is not always obvious. "Diabetes is one of those silent diseases," Maignan said. "Someone can be living with diabetes, it could be uncontrolled, and you would never know, but eventually, those elevated glucose levels will send them essentially to the hospital."
Maignan said when insulin is needed but not consistently available, high blood sugar can damage blood vessels and organs, including the eyes, kidneys and heart. For people with Type 1 diabetes (search), she said the danger can escalate much faster. "For patients living with Type 1, it could be a matter of just a few days to weeks before they could be pushed into that acute crisis and be hospitalized," she said.
Pharmacist William Parker of DeliveRxd Pharmacy said delays in getting insulin can quickly become dangerous. "With insulin, a delay can be dangerous," Parker said. "Insulin is not optional, and diabetes (search) does not pause while a prior authorization is processed, a formulary exception is reviewed, or a shipment travels through the mail."
Medicare enrollees already pay no more than $35 for a one-month supply of each covered insulin under Medicare's insulin cost cap, and the deductible does not apply. The patients most exposed to list prices tend to be uninsured adults, workers on high-deductible plans, and people who pay coinsurance. Some patients have rationed doses because of cost, which can lead to dangerous complications.
A legal fight playing out across the country
Florida's case follows similar actions. The Federal Trade Commission (search) sued the three pharmacy benefit managers and their affiliated purchasing groups in September 2024, and Fierce reported that Express Scripts (search) and CVS have settled that case while Optum is working toward its own resolution. Delaware's attorney general filed a comparable lawsuit in the Court of Chancery in January against the same three drugmakers and three pharmacy benefit managers.
Public responses from the defendants to the Florida suit were not available in the reports MedicalDaily reviewed. In similar litigation, the companies have denied wrongdoing. Responding to an Ohio county lawsuit, Novo Nordisk said it believes the allegations against it are "meritless," according to WVXU. Sanofi said in the same case that its pricing practices have always complied with the law.
Pharmacy benefit managers and drugmakers have also blamed each other. In the Ohio case, CVS Caremark (search) said "pharmaceutical companies alone are responsible for the prices they set," according to Spectrum News. Sanofi said rebate savings negotiated by insurers and pharmacy benefit managers are not consistently passed on to patients. Those competing explanations are likely to be tested as the Florida case moves forward.
No trial date has been publicly announced, and cases of this size often take years to resolve. The case does not change anyone's price today, and it does not create a claims process for individual patients. Any restitution would depend on a court ruling or settlement. The stakes also reach employers and health plans, whose premiums are shaped by drug spending.
Patients struggling to afford insulin can ask a pharmacist about manufacturer savings programs, lower-cost unbranded or biosimilar versions, and whether their plan covers a preferred product at a lower copay. Anyone facing an insurance denial can ask a clinician about prior authorization or an appeal. Rationing insulin is dangerous; extreme thirst, frequent urination, nausea or vomiting, fruity-smelling breath, rapid breathing, or confusion can signal diabetic ketoacidosis (search), which requires emergency care.