The largest makers of insulin and GLP-1s, as well as pharmacy benefit manager giants and rebate companies, were sued by the Florida attorney general Tuesday in an antitrust case claiming unlawful collusion.

The state filed its case in Miami-Dade County Circuit Court against manufacturers Eli Lily, Novo Nordisk, and Sanofi, PBMs CVS Caremark, Express Scripts, and OptumRx, and rebate aggregators Zinc, Ascent, and Emisar. The complaint alleges a scheme that sets an inflated “published list” price for insulin and weight-loss drugs. The drugmakers allegedly distributed rebate cash to the companies in exchange for preferred placement in health plan formularies.

“The sticker price lands as a higher price on the consumers and the independent pharmacies than the negotiated price manufacturers discuss with PBMs,” Attorney General James Uthmeier (R) said in a Tampa press conference Tuesday. “It’s not active, fair competition that ensures that the lowest most competitive price will win.”

The complaint, which also includes UnitedHealth Group as a defendant, focuses on business relationships between the companies that produce roughly 90% of the world’s insulin and the three pharmacy benefit managers that process roughly 80% of US prescriptions. In a press release the state alleges, as an example, that Ely Lily lists one vial of Humalog insulin for $280 and gives about $210 of that to PBMs as rebates and discounts.

The lawsuit alleges violations of the Florida Deceptive and Unfair Trade Practices Act and the Florida Antitrust Act.

Roughly one-in-10 Floridians have diabetes, Uthmeier said. So he expects the damages of the suit “to be high enough” to alter company behavior.

“The challenged agreements unreasonably restrained trade by suppressing price competition, foreclosing lower-cost insulin and insulin-adjunct products, distorting formulary competition, and preventing Florida consumers from benefiting from lower pricing and increased choice,” the complaint said.

The defendants didn’t immediately respond to a request for comment.

Lawson Huck Gonzalez, the Ferraro Law Firm and Ged Lawyers LLP joined the Florida Attorney General’s Office in representing the state.

The case is State of Florida, Off. of Attorney Gen., Dep’t of Legal Affairs v. Eli Lily and Co., Fla. Cir. Ct., complaint filed 9/22/26.