Florida sues Lilly, Novo Nordisk, Sanofi and three PBMs, alleging an insulin pricing scheme

Florida sued the three companies that make most of the world’s insulin, the three largest pharmacy benefit managers and the rebate companies those managers use, alleging that they worked together to keep insulin list prices high. Attorney General James Uthmeier announced the suit on September 22, 2026. The complaint was filed that day in the Circuit Court of the Eleventh Judicial Circuit in Miami-Dade County, according to Bloomberg Law, which gives the caption as State of Florida, Office of the Attorney General, Department of Legal Affairs v. Eli Lilly and Co. and reports that a docket number was not yet available.

The defendants

The manufacturers are Eli Lilly, Novo Nordisk and Sanofi, which the attorney general’s office says supply more than 90 percent of the world’s insulin. The pharmacy benefit managers are CVS Caremark, Express Scripts and OptumRx, which the office says process roughly 80 percent of U.S. prescriptions. The rebate aggregators are Zinc, Ascent and Emisar; Fierce Healthcare identifies them as Zinc Health Services, Ascent Health Services and Emisar Pharma Services, the group purchasing organizations affiliated with the three managers.

The attorney general’s release names those nine companies. Two news reports name a tenth defendant from the UnitedHealth family: Bloomberg Law reports that the complaint “also includes UnitedHealth Group as a defendant,” and WUSF lists UnitedHealthcare Insurance. The desk has not reviewed the complaint and cannot say which entity is named.

Bloomberg Law reported that Lawson Huck Gonzalez, the Ferraro Law Firm and Ged Lawyers LLP joined the attorney general’s office in representing the state.

What the state alleges

The release describes the theory this way: insulin has a published list price and a lower net price that the manufacturer keeps after rebates, and many patients, including the uninsured, those in a deductible and those on percentage-based coinsurance, pay against the list price. It alleges that the manufacturers inflated list prices for insulin and related diabetes drugs and paid rebates and fees to the pharmacy benefit managers in exchange for preferred placement on formularies, so that both sides profited when list prices rose.

The release cites testimony by a Lilly executive that of every $280 vial of Humalog, Lilly pays about $210, roughly 75 percent, back to pharmacy benefit managers as rebates and discounts. Fierce Healthcare noted that it was not clear how recent that testimony was. The suit also covers GLP-1 and combination products, which the release lists as Ozempic, Trulicity, Victoza and Soliqua. The release says approximately 2.3 million Florida adults have diagnosed diabetes.

Bloomberg Law quoted the complaint: “The challenged agreements unreasonably restrained trade by suppressing price competition, foreclosing lower-cost insulin and insulin-adjunct products, distorting formulary competition, and preventing Florida consumers from benefiting from lower pricing and increased choice.”

The claims and the relief sought

The complaint brings two counts under the Florida Deceptive and Unfair Trade Practices Act and one count under the Florida Antitrust Act. The state seeks a permanent injunction, restitution, disgorgement, damages, civil penalties and other relief. At a news conference in Tampa, Uthmeier said he expected damages “to be high enough” to change the companies’ behavior, Bloomberg Law reported.

What the defendants said

Bloomberg Law reported these statements. A Lilly spokesperson said: “It is unfortunate that the Florida AG would decide to expend state resources on suing a company that has led the way in making insulin more affordable. Other states have settled similar cases for no money after years of costly litigation.” CVS said: “Allegations that we play any role in determining the prices charged by manufacturers for their products are false, and we intend to vigorously defend against this baseless suit.” Novo Nordisk said it “believes that the allegations against it are meritless” and intends to defend against them. Sanofi said it would not comment on the specifics but that its “pricing practices have always complied with the law.” The sources reviewed carried no statement from Express Scripts, OptumRx, the rebate aggregators or UnitedHealth.

The federal case in the background

On September 20, 2024, the Federal Trade Commission filed an administrative complaint against Caremark Rx, Express Scripts and OptumRx and their affiliated group purchasing organizations, Zinc, Ascent and Emisar, over rebating practices it said inflated insulin prices. The FTC did not name the manufacturers; its Bureau of Competition said in a separate statement that manufacturers including Lilly, Novo Nordisk and Sanofi were on notice. Fierce Healthcare reported that Express Scripts and CVS have settled the FTC case and that the agency and Optum are working toward a settlement. Florida’s suit differs in naming the manufacturers as defendants and in proceeding under state law in state court.

What is not yet known

The docket number, the assigned judge and the exact UnitedHealth entity named were not in the sources reviewed. No defendant had filed a response. The complaint’s damages figure, if it states one, and the time period it covers were not reported. The desk did not review the complaint itself; allegations are stated as the attorney general’s release and the reporting describe them.