Florida Attorney General James Uthmeier has filed a lawsuit against three of the world's largest insulin manufacturers — Eli Lilly, Novo Nordisk, and Sanofi — along with the PBM industry's "Big Three": CVS Caremark, Express Scripts, and Optum Rx. The suit, filed in Florida's 11th Judicial Circuit Court, also names the PBMs' associated group purchasing organizations. Uthmeier alleges the companies worked in tandem to artificially inflate insulin prices while funneling large rebates back to PBMs in exchange for favorable formulary placement.

The lawsuit echoes a September 2024 FTC complaint that targeted PBMs and GPOs for "rigging pharmaceutical supply chain competition," though the FTC stopped short of suing the manufacturers at that time. Express Scripts and CVS have since settled with the FTC, while Optum Rx is working toward its own resolution. Florida's action goes a step further by holding drugmakers equally accountable.

By the Numbers:

• Eli Lilly, Novo Nordisk, and Sanofi collectively produce ~90% of the world's insulin
• For each $280 vial of Humalog insulin, ~$210 (75%) is reportedly rebated back to PBMs for formulary placement

Why it matters: Insulin is a life-sustaining medication for millions of Americans with diabetes. This lawsuit signals growing state-level pressure on the pharmaceutical supply chain and could set a precedent for holding both manufacturers and PBMs legally accountable for drug pricing practices.