ACCOUNTABILITY
On Sept. 22, Florida Attorney General James Uthmeier filed a lawsuit against three of the world’s largest insulin manufacturers, three major pharmacy benefit managers and several rebate aggregators, alleging a coordinated scheme to inflate insulin prices at the expense of patients who cannot live without the drug.
- The complaint names insulin manufacturers Eli Lilly, Novo Nordisk and Sanofi — which together supply more than 90 percent of the world’s insulin — along with pharmacy benefit managers CVS Caremark, Express Scripts and OptumRx, which collectively process roughly 80 percent of U.S. prescriptions. Also named are rebate aggregators Zinc, Ascent and Emisar.
“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. My office is holding them accountable.”
This isn’t a new problem, and it isn’t a new allegation. In March 2023, I interviewed attorney Troy Rafferty about the mass tort he had filed against Eli Lilly, Novo Nordisk and Sanofi over insulin price-fixing.
What Rafferty Told Me in 2023
At the time, Lilly and Novo Nordisk had just announced headline-grabbing price cuts—up to 70% and 75%, respectively—along with caps limiting patient out-of-pocket costs to $35 a month. Rafferty wasn’t buying it.
- “It’s actually kind of just a facade or putting a Band-Aid on a compound fracture,” he told me. “It’s not really going to change anything, what they’re doing right now.”
The numbers he laid out then still hold up. Insulin costs pennies to produce. More than 37 million Americans have diabetes, and 8.4 million of them depend on insulin. One in four ration their doses because they can’t afford the full amount—a decision that can lead to blindness, kidney failure, amputation and death.
- Americans make up only 15% of the global insulin market, yet account for nearly half of all insulin-related revenue worldwide
- Diabetic families were spending roughly 40% of their post-subsistence income on the drug
- Rafferty predicted discovery would show the three manufacturers moved “in lockstep” on pricing for years
The PBMs have been under fire for a while now, too. The FTC sued Caremark, Express Scripts and OptumRx back in September 2024 over the same rebate practices Uthmeier is now targeting at the state level. Express Scripts and Caremark have since settled with the FTC; Uthmeier’s office had already sent CVS/Caremark a civil investigative demand of its own over pharmacy competition concerns.
Rafferty’s line from 2023 is worth remembering here: a price cut announced in a press release isn’t accountability.
- A lawsuit, a discovery process and a court record are. Florida just decided to build that record itself.
Note: Rafferty formed a new firm, Rafferty Domnick Cunningham & Yaffa, in October 2024. Rafferty Domnick Cunningham & Yaffa and Levin Papantonio are both involved in litigation regarding insulin price-fixing.