Florida sues insulin makers, PBMs and UnitedHealth Group over list prices and rebates

What Florida alleges

The complaint was filed in Florida's 11th Judicial Circuit in Miami-Dade County on 22 September, Bloomberg Law reported. The defendants are Eli Lilly, Novo Nordisk and Sanofi, which supply more than 90% of the world's insulin, according to the attorney general; CVS Caremark, Express Scripts and OptumRx, the pharmacy benefit managers that process about 80% of U.S. prescriptions; rebate aggregators Zinc, Ascent and Emisar; and UnitedHealth Group, which Bloomberg Law lists as a defendant. The state alleges the manufacturers inflated published list prices, then paid rebates and fees to the PBMs for preferred formulary placement. Uthmeier said all the defendants profited as the sticker price rose.

Patients who are uninsured, inside a deductible or on percentage coinsurance are billed against the list price, not the net price after rebates, Uthmeier said. The complaint rests on that gap.

The suit also covers GLP-1 and combination products including Ozempic, Trulicity, Victoza and Soliqua. It brings two counts under the Florida Deceptive and Unfair Trade Practices Act and one under the Florida Antitrust Act. Uthmeier's office seeks a permanent injunction, restitution, disgorgement, damages and civil penalties. No court has ruled on the claims, and no trial date has been publicly announced.

The $280 vial and the list-price gap

Uthmeier cited a Lilly executive's testimony about the Humalog vial. Of every $280 vial, the company provides about $210, or 75%, to PBMs as rebates and discounts, he said. Fierce Healthcare noted it was not immediately clear how recent that testimony was.

The lawsuit says insulin manufacturing costs "only a few dollars per vial". It also cites patient cost data. About 2.3 million Florida adults, roughly one in 10, have diagnosed diabetes, according to the lawsuit. The lawsuit alleges that about 14% of Americans who use insulin, more than 1.1 million people, experienced "catastrophic" spending, which it defines as at least 40% of the income left after food and housing going to insulin alone. It also alleges that about one in four patients reported rationing insulin because of cost.

Uthmeier said he expects damages "to be high enough" to change company behavior. He gave no figure.

The companies deny the claims

Lilly called the suit "unfortunate". It said Florida was spending state resources suing a firm that "has led the way in making insulin more affordable". Other states had settled similar cases for no money, Lilly said. CVS said allegations that it plays any role in determining manufacturers' prices are false, and that it intends to "vigorously defend against this baseless suit". Novo Nordisk called the allegations "meritless" and said it intends to "vigorously defend against these claims". Sanofi said its pricing practices "have always complied with the law" and that it is committed to helping patients get medicine at the lowest possible price.

What happens next

Bloomberg Law said the docket number was unavailable. The case is listed as State of Florida, Off. of Attorney Gen., Dep't of Legal Affairs v. Eli Lilly and Co.

Florida's suit follows a federal FTC action against the three PBMs filed in September 2024. Express Scripts and CVS have settled that case while Optum works toward its own resolution, Medical Daily reported, citing Fierce. Delaware's attorney general filed a comparable case in January against the same three manufacturers and three PBMs, according to the same report. Cases of this size often take years to resolve, Medical Daily reported.