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For Floridians with Type 1 diabetes, insulin is not optional. Many people with Type 2 diabetes depend on it too, along with newer medications such as Ozempic. When the price of a medicine like that rises, families feel it at the pharmacy counter, in their monthly budgets, and in the choices they are forced to make.
On September 22, 2026, Florida Attorney General James Uthmeier filed a lawsuit against the companies at the center of the insulin supply chain. The complaint alleges that insulin manufacturers and the nation’s largest pharmacy benefit managers (PBMs) used rebate and formulary agreements that drove up the price Floridians paid for insulin and other diabetes drugs.
“These companies told Florida families they were working to make insulin affordable,” Attorney General Uthmeier said. “Instead, they inflated the sticker price of a medicine people cannot live without and left Florida patients to pay it. My office is holding them accountable.”
Ferraro Law is one of the firms serving as outside counsel for the State in this case. Below, we explain what the lawsuit alleges, who is named, and what it could mean for Florida.
Who Is Named in the Lawsuit
The complaint was filed in the Circuit Court of the Eleventh Judicial Circuit in and for Miami-Dade County. It names three groups of defendants.
- Insulin manufacturers: Eli Lilly, Novo Nordisk, and Sanofi. According to the complaint, they control more than 90% of the global insulin supply.
- Pharmacy benefit managers (PBMs): CVS Caremark, Express Scripts, and OptumRx. The complaint states they process about 80% of prescription claims nationwide.
- Rebate aggregators: Zinc, Ascent, and Emisar. The complaint alleges these entities were created or used by the PBMs between 2019 and 2021 to negotiate and process manufacturer payments.
The complaint also names related parent companies and affiliates of these businesses.
What the Complaint Alleges
Insulin has two prices. The first is the list price, the published “sticker price” set by the manufacturer. The second is the net price, what the manufacturer actually keeps after paying rebates and fees.
The complaint alleges that the manufacturers set high list prices and then paid a large share back to the PBMs as rebates, fees, and other payments. In exchange, their drugs received preferred or exclusive placement on the formularies that decide which medications a health plan will cover. Because many of those payments were calculated as a percentage of the list price, the State alleges the system rewarded higher list prices and disadvantaged lower-priced alternatives.
At the press conference announcing the lawsuit, Attorney General Uthmeier pointed to testimony from an Eli Lilly executive. According to the Attorney General, of every $280 vial of Humalog, Lilly hands about $210, roughly 75%, back to PBMs as rebates and discounts.
The complaint describes how prices moved over time. It alleges that some insulin products rose in price by more than 1,000%, reaching about $350 per vial, even though manufacturing costs only a few dollars per vial. Several of these insulins, the complaint states, are substantially similar to products sold in the 1990s for about $20 a vial.
The period at issue runs from January 1, 2011 to January 1, 2023. The complaint acknowledges that manufacturers announced list-price reductions on certain older insulins in 2023 and 2024. It alleges those changes do not undo past overpayments or show that the underlying practices have stopped.
Why List Prices Matter to Florida Patients
Many patients never pay the negotiated net price. People without insurance, people who have not yet met their deductible, and people with percentage-based coinsurance are often charged based on the list price. That means an inflated sticker price can land directly on the patient.
The stakes in Florida are significant. According to the complaint:
- About 2.3 million Florida adults, roughly 1 in 10, have diagnosed diabetes.
- Diabetes costs the State an estimated $30.5 billion each year, including $24 billion in direct medical expenses.
- About one in four patients nationally reported rationing insulin because of its cost.
“Insulin is not a discretionary drug for a lot of people,” the Attorney General said at the press conference. For many Floridians, he noted, it can be the difference between life and death.
The Lawsuit Also Covers Ozempic and Other GLP-1 Drugs
The case reaches beyond insulin. The complaint alleges the same kinds of rebate and formulary arrangements affected other diabetes medications, including the GLP-1 drugs Ozempic, Trulicity, and Victoza, and the combination product Soliqua.
In one example described in the complaint, a manufacturer tied its largest insulin rebates to plans also giving preferred placement to its GLP‑1 drug and excluding competing products.
What Florida Is Asking the Court to Do
The complaint brings three counts against all defendants:
- A claim under the Florida Deceptive and Unfair Trade Practices Act (FDUTPA) related to insulin
- A second FDUTPA claim related to insulin adjuncts, including GLP-1 drugs
- A claim under the Florida Antitrust Act
The State is asking the court for a permanent injunction to stop the challenged practices, along with restitution, disgorgement, damages, civil penalties, and attorneys’ fees. The State has also demanded a jury trial.
The defendants have not yet responded to the complaint in court. The allegations have not been proven, and the case is in its earliest stage.
Read the Full Complaint
The State’s 113-page complaint, filed September 22, 2026, in Miami-Dade County Circuit Court, explains the alleged rebate and formulary scheme in detail. It includes internal manufacturer documents, price-history charts and the specific claims against each defendant.
Ferraro Law’s Role in the Case
The State is represented by the Office of the Attorney General together with outside counsel The Ferraro Law Firm, P.A., Lawson Huck Gonzalez, PLLC, and Ged Lawyers, LLP. Natalia M. Salas and James L. Ferraro, Jr. are counsel of record for The Ferraro Law Firm, P.A.
For more than 40 years, Ferraro Law has worked on behalf of people and communities harmed by powerful corporations. Our work for government entities includes PFAS litigation that has secured more than $250 million in settlements for cities throughout Florida and the United States. We bring the same disciplined preparation and strategic advocacy to insulin pricing litigation.
What’s next?
If your organization pays for prescription coverage and has seen insulin costs rise without explanation, you may be eligible to pursue a claim. Ferraro Law represents self-funded health plans, public entities, and other payors nationwide from our Miami headquarters. We listen to your circumstances and help you understand your options. Tell us what happened.
The information on this website is for general purposes only and does not constitute legal advice or create an attorney-client relationship. The allegations described in this post are claims made in a pending lawsuit and have not been proven in court.Frequently Asked Questions
Frequently Asked Questions
Why is insulin so expensive if it costs little to make?
The complaint alleges that the answer lies in how insulin is sold, not how it is made. According to the State, manufacturers raised list prices and paid large rebates to PBMs for preferred formulary placement. Because those payments were often tied to the list price, the system allegedly rewarded higher prices. Patients who pay based on list price, such as those who are uninsured or in a deductible, bear the difference.
What is a pharmacy benefit manager?
A pharmacy benefit manager, or PBM, runs prescription drug benefits for health plans and employers. PBMs build formularies, the lists of covered drugs, process claims, and negotiate rebates with drug manufacturers. The three PBMs named in Florida's lawsuit, CVS Caremark, Express Scripts, and OptumRx, process about 80% of prescription claims in the United States, according to the complaint.
Can I join the Florida insulin lawsuit?
This case was brought by the State of Florida through the Attorney General's Office. It is not a class action, and individual patients are not parties to it. Employers, unions, self-funded health plans, and local governments that paid for insulin through prescription coverage may have separate claims of their own. Ferraro Law can review your organization's situation in a free consultation.
Does the lawsuit cover Ozempic?
Yes. In addition to insulin, the complaint covers GLP‑1 and combination diabetes drugs, including Ozempic, Trulicity, Victoza, and Soliqua. The State alleges the same rebate and formulary practices affected the prices of these medications. The second FDUTPA count in the complaint focuses specifically on these insulin adjuncts.
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