Florida sues insulin makers and middlemen over price rises

Florida's attorney-general is suing three drugmakers and three pharmacy benefit managers, alleging they worked together to inflate insulin prices and profit from the increases.

The suit, filed in the state's 11th Judicial Circuit Court, names Eli Lilly (LLY), Novo Nordisk (NVO) and Sanofi (SNY), which James Uthmeier's office said produce 90 per cent of the world's insulin. It also targets the PBM industry's "Big Three": CVS Caremark, part of CVS Health (CVS); Express Scripts, owned by Cigna (CI); and Optum Rx, part of UnitedHealth (UNH). Their affiliated group purchasing organizations, Ascent Health Services, Zinc Health Services and Emisar Pharma Services, are also defendants.

Uthmeier argues that the manufacturers deliberately set high list prices for insulin and related diabetes drugs, including leading GLP-1s, then paid large fees and rebates to the PBMs to secure formulary placement, ensuring that each side profited as prices rose.

"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 and left Florida patients to pay it."

The complaint cites testimony from a Lilly executive that, for each $280 vial of Humalog, $210, or about 75 per cent, is rebated to PBMs in exchange for formulary placement. It is unclear how recent the testimony is.

The action follows a similar case brought by the Federal Trade Commission, which sued the PBMs and their GPOs in September 2024 after a lengthy investigation. The agency alleged the vertically integrated groups were "rigging pharmaceutical supply chain competition in their favor," arguing that high list prices generated rebates the PBMs used to bolster their finances. It did not pursue the manufacturers but warned that their pricing practices warranted scrutiny. Express Scripts and CVS have since settled, while Optum is working toward a resolution with the agency.