Insulin Price Lawsuit: Florida Sues Lilly, Novo, Sanofi and PBMs

On 22 September 2026, Florida's attorney general announced a lawsuit against the three companies that make more than 90% of the world's insulin, Eli Lilly, Novo Nordisk and Sanofi.¹ It also names the three largest pharmacy benefit managers, the middlemen who negotiate drug prices for US insurers: CVS Caremark, Express Scripts and OptumRx.¹

The claim is that both sides profited from high list prices. Drugmakers raised the sticker price and paid larger rebates to the middlemen in return for favoured placement on insurers' drug lists, the complaint alleges.² The patients who paid the sticker price carried the cost, Florida says. KFF Health News listed the case in its national health briefing two days later.³ This article sets out what Florida alleges, where a parallel federal case stands, and how US insulin prices compare with other countries.

What Florida alleges

Attorney General James Uthmeier filed the case in Florida's 11th Judicial Circuit, in Miami-Dade County.² Besides the three insulin makers and three pharmacy benefit managers, it names three rebate aggregators linked to them: Zinc, Ascent and Emisar.¹

The complaint alleges that manufacturers "inflated published prices for insulin and related diabetes medications". It says they then paid rebates and fees to the pharmacy benefit managers "in exchange for preferred formulary placement".² The three managers process roughly 80% of US prescriptions.¹

The lawsuit cites one specific figure. A Lilly executive testified that roughly 75% of a $280 vial's price went to rebates and discounts, according to local reporting of the case.¹²

Florida brings two counts under its Deceptive and Unfair Trade Practices Act and one under its Antitrust Act.¹ It asks for an injunction, restitution and damages.¹ About 2.3 million Florida adults, one in ten, have diagnosed diabetes.¹

"These companies told Florida families they were working to make insulin affordable," Uthmeier said. "Instead, they inflated the sticker price of a medicine people cannot live without."¹

No company response appears in the reports reviewed here.¹²

The federal case it echoes

The Federal Trade Commission brought a similar case in September 2024. It accused the same three pharmacy benefit managers and their rebate affiliates of rebating practices that inflated insulin list prices.⁴

That case has largely moved to settlement. The commission reached a settlement with Express Scripts on 4 February 2026, with ten years of commitments on pricing, transparency and how the company is paid.⁵ Caremark was withdrawn from the case on 23 March 2026 so that a proposed consent agreement could be considered.⁴ As of a filing on 13 April 2026, the commission was still negotiating with OptumRx.⁴

None of those steps is a court finding against the companies. They are agreements to change practices.

How US prices compare

The international gap is the best-measured part of the story. The RAND Corporation compared insulin prices in 2022 between the US and 33 other countries in the Organisation for Economic Co-operation and Development (OECD).⁶

US manufacturer gross prices per 100 units were 9.71 times those in the comparison countries combined.⁶ After estimating rebates and discounts, US net prices were still 2.33 times higher.⁶ US gross prices ranged from 4.6 times Mexico's to 38 times Türkiye's.⁶

That difference between gross and net is the mechanism Florida's lawsuit targets. Rebates lower the price insurers pay. They do not lower the price of a patient who pays the list price, for example during a deductible.

Patients feel it directly. The US health department's planning office found an average out-of-pocket cost of $58 per insulin fill in 2019. People uninsured all year paid $123 on average.⁷

What has already changed

Prices have moved since the period the lawsuit covers. In March 2023, Lilly said it would cut list prices of Humalog and Humulin by 70%. Novo Nordisk announced cuts of up to 75%, and Sanofi a 78% cut to Lantus, both taking effect in January 2024.⁸ All three committed to $35 monthly out-of-pocket caps for many patients.⁸

Federal law also caps costs for older Americans. Since 1 January 2023, Medicare Part D has capped insulin cost-sharing at $35 per month's supply, with a similar cap in Part B from July 2023.⁷

The UK takes a different route. People in England with diabetes treated by more than diet alone can get a medical exemption certificate, which makes their NHS prescriptions free.⁹

What the headline leaves out

The lawsuit is about past pricing. The list price cuts announced in 2023 took effect in 2023 and 2024.⁸ The reports reviewed here do not say how the complaint treats them.

The RAND figures are for 2022.⁶ They predate those cuts, so the current gap may be smaller. RAND's report reviewed here does not measure it.

And a lawsuit is not a finding. Florida's claims will be tested in court. The federal case produced settlements rather than a ruling on the facts.⁴⁵

What this means for you

If you buy insulin in the US, check which payment applies to you: list price, a manufacturer's $35 programme, or Medicare's cap. Manufacturer programmes have conditions, so ask your pharmacist which one you qualify for.

If you live in England and use insulin, check that you hold a valid medical exemption certificate. It lasts up to ten years and covers all your prescriptions.⁹

Footnotes

1. https://www.news4jax.com/news/local/2026/09/22/florida-ag-sues-insulin-makers-pharmacy-benefit-manager-over-high-prices/ — News4JAX, "Florida AG sues insulin makers, pharmacy benefit manager over high prices" (published Sep 22, 2026). Accessed Oct 3, 2026. ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰

2. https://www.wlrn.org/health/2026-09-25/florida-ag-uthmeier-alleges-insulin-price-collusion-in-lawsuit-against-drugmakers-pbms — WLRN, "Florida AG Uthmeier alleges insulin price collusion in lawsuit against drugmakers, PBMs" (published Sep 25, 2026). Accessed Oct 3, 2026. ↩ ↩² ↩³ ↩⁴ ↩⁵

3. https://kffhealthnews.org/morning-briefing/thursday-september-24-2026/ — KFF Health News, Morning Briefing (published Sep 24, 2026). Accessed Oct 3, 2026. ↩

4. https://www.ftc.gov/system/files/ftc_gov/pdf/615258.2026.04.13_joint_expedited_motion_to_extend_stay.pdf — Federal Trade Commission, Docket No. 9437, joint expedited motion to extend the stay of the administrative proceeding (filed Apr 13, 2026). Accessed Oct 3, 2026. ↩ ↩² ↩³ ↩⁴

5. https://natlawreview.com/article/settlement-dominoes-ftcs-pbm-playbook-going-industrywide — The National Law Review, "Settlement dominoes: the FTC's PBM playbook is going industrywide" (published Mar 10, 2026). Accessed Oct 3, 2026. ↩ ↩²

6. https://www.rand.org/pubs/periodicals/health-quarterly/issues/v11/n3/03.html — RAND Corporation, "Comparing Insulin Prices in the United States to Other Countries: Updated Results Using 2022 Data", RAND Health Quarterly (published 2024). Accessed Oct 3, 2026. ↩ ↩² ↩³ ↩⁴ ↩⁵

7. https://www.aspe.hhs.gov/sites/default/files/documents/ae8306ca30f1d639076cf7633fc2d8fd/aspe-insulin-affordibility-datapoint.pdf — Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, "Insulin Affordability and the Inflation Reduction Act" (HP-2023-02, published 2023). Accessed Oct 3, 2026. ↩ ↩²

8. https://gabionline.net/biosimilars/general/lilly-novo-nordisk-and-sanofi-slash-prices-of-insulin-in-the-us — GaBI Online, "Lilly, Novo Nordisk and Sanofi slash prices of insulin in the US" (published Mar 23, 2023). Accessed Oct 3, 2026. ↩ ↩² ↩³

9. https://www.nhsbsa.nhs.uk/exemption-certificates/medical-exemption-certificates — NHS Business Services Authority, "Medical exemption certificates". Accessed Oct 3, 2026. ↩ ↩²

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