A vial of insulin costs about $2 to produce.
CVS, Express Scripts, and OptumRx are charging Floridians up to $700 for it.
Florida Attorney General James Uthmeier just dropped the hammer on companies placing a 14,900% markup on this critical drug for diabetics.
The Scheme That's Been Killing Americans
This isn't complicated once you understand how the scam works.
Three companies make nearly all the world's insulin – Eli Lilly, Novo Nordisk, and Sanofi.
Three companies process nearly all U.S. prescriptions – CVS Caremark, Express Scripts, and OptumRx.
Those six companies built a system that enriches all of them and crushes everyone else.
https://twitter.com/AGJamesUthmeier/status/2102502910089142730?s=20
Manufacturers publish an artificially inflated "list price" for insulin.
PBMs – the industry term for prescription middlemen – then negotiate secret rebates with manufacturers in exchange for favorable placement on the drug lists that determine what insurance plans will cover.
The more the manufacturer inflates the list price, the bigger the rebate they can pay the PBM.
The bigger the rebate, the better the formulary position.
So manufacturers keep raising prices, PBMs keep pocketing larger cuts, and the diabetic at the pharmacy window – paying out of pocket based on that inflated list price – gets destroyed.
A drug that cost $20 per vial in the 1990s now lists at $300 to $700.
It still costs about $2 to $4 to manufacture.
Senate investigators documented the pattern in detail: Sanofi paid rebates worth 2% to 4% of its insulin list price in 2013 – and 56% in 2018.
Over that same period, the price of their Lantus insulin tripled.
Washington, DC Watched and Did Nothing
Here is what your elected officials in Washington, DC did while diabetics were rationing insulin.
Pharmaceutical companies poured millions into Democratic campaigns – party committees, Senate races, and every Democrat who talked loudest about lowering drug prices.
The FTC eventually filed its own lawsuit against these same three PBMs in September 2024.
Then the case collapsed into chaos.
https://twitter.com/AGJamesUthmeier/status/2102480751459766735?s=20
When Trump fired the two Democrat FTC commissioners in March 2025, the agency lost its quorum – both Republican commissioners had already recused themselves – and the lawsuit ground to a halt.
The companies that had been rigging insulin prices for a decade caught a procedural break that kept them out of federal court.
That is exactly why Uthmeier's state-level lawsuit matters.
Florida doesn't need Congress to act or Washington appointees to agree.
Florida has 2.3 million adults with diagnosed diabetes, a state antitrust statute, and an attorney general with a Trump endorsement and nothing to fear.
Why This One Can Win
Uthmeier filed under Florida's Deceptive and Unfair Trade Practices Act and the Florida Antitrust Act.
The state is seeking a permanent injunction, restitution, disgorgement, damages, and civil penalties.
Disgorgement is the key word.
That means forcing these companies to give back every dollar of profit tied to the alleged fraud – not just pay a fine and move on.
"People should not have to live in fear over the price of a life and death drug," Uthmeier said at Tuesday's announcement.
“These companies told Florida families they were working to make insulin affordable,” Uthmeier continued. “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.”
State Representative Danny Alvarez put it even more plainly: "What we will never stand for is for you rigging the system so that you win and our people lose."
Uthmeier told reporters more drug pricing lawsuits are coming in the weeks and months ahead.
The companies that spent decades running this scheme behind closed doors – protected by campaign cash and federal paralysis – are now answering to a state that has 2.3 million reasons to make them pay.
That's a different kind of math entirely.
Sources:
- Kennedy Owens, "Uthmeier takes aim at insulin pricing in new Florida lawsuit," Florida Voice News, September 22, 2026.
- "Grassley, Wyden Question Role of Middlemen in Skyrocketing Insulin Prices," Senate Finance Committee, grassley.senate.gov.
- "News Briefs: Firing of FTC Commissioners May Impact PBM Case," AIS Health, aishealth.mmitnetwork.com, March 27, 2025.
- "FTC Chair Ferguson Changes Course on Recusal from PBM Insulin Case," Fierce Healthcare, April 2025.
