Florida Attorney General James Uthmeier is suing three drug manufacturers as well as three pharmacy benefit managers, alleging that they worked together to drive up the price of insulin and line their own pockets.

In the lawsuit, filed this week in the state's 11th Judicial Circuit Court, targets Eli Lilly, Novo Nordisk and Sanofi, which Uthmeier's office said produce 90% of the world's insulin, alongside the PBM industry's "Big Three" organizations, CVS Caremark, Express Scripts and Optum Rx.

It also includes the three PBMs' associated group purchasing organization—Zinc Health Services, Ascent Health Services and Emisar Pharma Services, respectively.

Uthmeier argues that the drugmakers deliberately set high prices for insulin and other associated diabetes drugs, including leading GLP-1s, and then paid significant fees and rebates to the PBMs to secure formulary placement, ensuring each profited from rising prices.

“These companies told Florida families they were working to make insulin affordable,” Uthmeier said in a statement. “Instead, they inflated the sticker price of a medicine people cannot live without and left Florida patients to pay it."

The lawsuit echoes legal action undertaken by the Federal Trade Commission, which similarly targeted leading PBMs and GPOs over their role in the rising price of insulin. Express Scripts and CVS settled that case, while the feds and Optum are working toward their own settlement resolution.

Uthmeier's lawsuit cites testimony from an executive at Lilly that for each $280 vial of its Humalog insulin, $210, or about 75% is rebated back to PBMs in exchange for formulary placement.

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