Florida Insulin Price Lawsuit 2026: What Physicians Should Do

On September 22, Florida Attorney General James Uthmeier stood in a Tampa pharmacy and announced that the state had sued the three companies that make more than 90 percent of the world’s insulin, the three pharmacy benefit managers that process about 80 percent of American prescriptions, and the three rebate aggregators those PBMs own. The complaint, filed in the Eleventh Judicial Circuit in Miami-Dade County, brings one count under the Florida Antitrust Act and two under the Florida Deceptive and Unfair Trade Practices Act. Every Florida physician who has written an insulin prescription in the last decade has been working inside the arrangement it describes.

What the State Alleges

The defendants are Eli Lilly, Novo Nordisk, and Sanofi on the manufacturing side; CVS Caremark, Express Scripts, and OptumRx on the PBM side; and Zinc, Ascent, and Emisar, the group purchasing organizations the three PBMs created to negotiate rebates. WUSF’s report on the complaint also lists UnitedHealthcare Insurance among the defendants.

The theory is the one the Federal Trade Commission laid out in its own administrative complaint against the same three PBMs and their aggregators on September 20, 2024. Manufacturers raised the published list price of insulin year after year. They then paid most of that increase back to the PBMs as rebates. In return, the PBMs gave the highest-rebate products preferred placement on their formularies and excluded lower-priced versions of the same molecule. The state’s complaint describes this as a quid pro quo that ran from 2011 to 2023 and uses one product as its example: a $280 vial of Humalog on which Lilly paid roughly $210, about 75 percent, back to the PBMs and their aggregators.

The people who paid the list price were the ones with no one negotiating for them: patients in a deductible phase, patients with coinsurance calculated on the list price, and the uninsured. According to the Tampa Free Press account of the complaint, the state’s claims also reach the GLP-1 products Ozempic, Trulicity, Victoza, and Soliqua.

Florida is asking for a permanent injunction, restitution, disgorgement, damages, and civil penalties. Uthmeier said at the news conference that more lawsuits are coming in the weeks and months ahead. None of the defendants had responded publicly as of this writing.

What Has Already Changed, and What Has Not

Some of the pricing the complaint describes has already moved. Medicare Part D has capped insulin at $35 a month since January 2023 under the Inflation Reduction Act. On March 1, 2023, Lilly announced it would cut the list price of Humalog from $274.70 to $66.40 a vial and cap out-of-pocket cost at $35 a month for commercially insured patients, and Novo Nordisk and Sanofi announced their own cuts within weeks.

The rebate system itself did not change. The same three PBMs still decide which products are preferred, which are excluded, and which require a prior authorization or a step through a different agent first. The Florida Legislature passed the Prescription Drug Reform Act in 2023, chapter 2023-29, by a vote of 40 to 0 in the Senate and 118 to 0 in the House. It put PBMs under the Office of Insurance Regulation, required pass-through pricing to pharmacies, required 100 percent of manufacturer rebates to flow to the plan, and gave patients a 60-day continuity-of-care period when a formulary is revised during a plan year.

Why It Matters for Florida Physicians

About 2.3 million Florida adults have diagnosed diabetes, roughly one in ten. The complaint cites survey data in which one in four insulin users reported rationing because of cost, and about 14 percent faced what the state calls catastrophic spending, more than 40 percent of their remaining income.

The mechanism the state is attacking is the formulary, and the formulary is where the physician’s judgment gets overridden. When a PBM moves a patient’s insulin off the preferred tier in January, the physician did not make that decision and usually does not learn about it until the pharmacy calls. The American Diabetes Association reports that more than 75 percent of patients find out about a coverage change when they arrive at the pharmacy, that most pharmacists describe a delay of three days or more before the replacement is in hand, and that about one in five patients report their glucose control was somewhat or much worse after a forced switch. Every one of those switches produces a prior authorization, an appeal, a sample closet visit, and a re-education session on a new pen, and the practice absorbs that work without payment.

If three quarters of a vial’s list price flows back to the intermediary, the price the patient sees at the counter was never a price for insulin. It was a price for formulary position.

What Florida Physicians Should Do Now

1. Ask every insulin patient what they paid at the counter last month and whether they have stretched a vial or a pen. Part D patients have the $35 cap. Commercially insured patients can use the manufacturer $35 programs from Lilly, Novo Nordisk, and Sanofi. The patients the complaint describes are the ones in a high-deductible plan or with no coverage at all, and they will not volunteer that they are rationing unless asked.
2. Learn the 60-day continuity-of-care rule in the Prescription Drug Reform Act and use it. When a plan revises its formulary in the middle of a plan year, the patient is entitled to 60 days of continued coverage at the same cost sharing. If a plan or PBM refuses, the complaint goes to the Office of Insurance Regulation, which now licenses PBMs.
3. Document every nonmedical switch in the chart as a clinical event: the date, the prior agent and dose, the replacement, the reason given by the plan, and the glucose and hypoglycemia data before and after. The ADA recommends this for appeals, and it is the same evidence the state will need to prove patient harm.
4. Read the annual formulary exclusion lists that Caremark, Express Scripts, and OptumRx publish each fall, and plan January transitions in the office before the pharmacy calls.
5. None of this constitutes legal advice, so if your practice is contacted by counsel for the state or for any defendant about patient records or prescribing patterns, speak with your own attorney before sharing anything. Physicians are not parties to this case.

The Bigger Picture

Florida’s case will take years. The physician is the only party in this chain with no financial stake in where the list price sits, and that is exactly why the profession has to be at the table when the Legislature returns to PBM reform in 2027. The 2023 law protected pharmacies and plans. It did not give the prescriber any standing when a formulary decision overrides a clinical one. The Florida Medical Association and the county medical societies have an opening this fall to ask for it.

Frequently Asked Questions

What did Florida’s Attorney General sue the insulin makers and PBMs for?

The complaint filed September 22, 2026 alleges that Eli Lilly, Novo Nordisk, Sanofi, CVS Caremark, Express Scripts, OptumRx, and three rebate aggregators coordinated to raise insulin list prices while trading rebates for formulary placement between 2011 and 2023. It brings one count under the Florida Antitrust Act and two under the Florida Deceptive and Unfair Trade Practices Act and seeks an injunction, restitution, damages, and civil penalties.

Does the Florida insulin lawsuit change what my patients pay today?

No. A lawsuit does not change prices until it produces a judgment or a settlement. What patients pay now depends on Medicare’s $35 Part D cap, the manufacturers’ $35 commercial programs announced in 2023, and their plan’s formulary and deductible. The case matters for physicians because it documents how formulary position is bought, not because it lowers a copay this month.

What is Florida’s 60-day continuity-of-care rule for prescription drugs?

The Prescription Drug Reform Act of 2023, chapter 2023-29, requires that when a health plan revises its formulary during a plan year, affected patients receive a 60-day period of continued coverage for the drug at the same cost sharing. The Office of Insurance Regulation handles complaints about PBM conduct under the act.

How do PBM rebates affect which insulin a Florida physician can prescribe?

PBMs build formularies in exchange for manufacturer rebates, and the products with the largest rebates tend to be the preferred ones. A lower-priced version of the same insulin can be excluded because it carries a smaller rebate. When that happens, the physician’s prescription is subject to a prior authorization or a forced switch, and the ADA reports that about one in five patients say their glucose control worsened after such a switch.

This article was drafted with the assistance of AI writing tools, then reviewed, edited, and approved by Dr. Sean C. Orr, M.D., who holds full editorial responsibility for its content. The header illustration was created with AI image tools.

References

1. WUSF / Health News Florida, “Florida AG Uthmeier alleges insulin price collusion in lawsuit against drugmakers, PBMs” (September 25, 2026). wusf.org
2. News4Jax, “Florida AG sues insulin makers, pharmacy benefit manager over high prices” (September 22, 2026). news4jax.com
3. FOX 35 Orlando, “Florida Attorney General targets insulin, diabetes-related drug prices in new lawsuit” (September 22, 2026). fox35orlando.com
4. Tampa Free Press, “Florida Sues Major Drugmakers And Middlemen Over Skyrocketing Insulin Prices” (September 2026). tampafp.com
5. MLex, “Insulin makers, PBMs’ ‘quid pro quo’ targeted by Florida AG antitrust suit” (September 2026). mlex.com
6. Federal Trade Commission, “FTC Sues Prescription Drug Middlemen for Artificially Inflating Insulin Drug Prices” (September 20, 2024). ftc.gov
7. The Florida Senate, bill summary, CS/CS/SB 1550 (2023), Prescription Drugs, chapter 2023-29, Laws of Florida. flsenate.gov
8. CBS News, “Eli Lilly to cut insulin prices by 70%, cap monthly costs at $35” (March 1, 2023). cbsnews.com
9. CNBC, “Facing political pressure, Sanofi follows Eli Lilly and Novo Nordisk in slashing insulin prices” (March 16, 2023). cnbc.com
10. American Diabetes Association, “Forced Nonmedical Switching.” diabetes.org