The Alleged Scheme
Insulin is a century-old, life-sustaining drug for people with diabetes, yet its US list price climbed dramatically over the past two decades. Lawsuits brought by states, cities and others target two groups: the three manufacturers that control almost the entire US insulin market — Eli Lilly, Novo Nordisk and Sanofi — and the largest pharmacy-benefit managers (PBMs), CVS Caremark, Express Scripts and OptumRx, which negotiate drug prices for insurers. The suits allege the two sides ran a scheme: manufacturers repeatedly raised list prices while paying ever-larger rebates to PBMs to secure favorable placement, so both profited from a high list price — while many patients, especially the uninsured or those with high-deductible plans, paid based on that inflated number.
The claims invoke consumer-protection laws and the federal racketeering (RICO) statute, framing the rebate arrangement as an unfair pricing arrangement rather than normal competition.
The Litigation Status
The federal cases were consolidated into a multidistrict litigation in New Jersey, gathering hundreds of cases from states and government entities. The litigation is active and being vigorously contested; there is no global settlement. Separately — and partly amid this pressure and public outcry — the manufacturers announced voluntary steps like capping out-of-pocket insulin costs at $35 a month for many patients, and federal law now caps insulin copays for people on Medicare.
Those price caps are welcome but are distinct from the lawsuits, which seek to hold the companies accountable for the alleged past scheme.
What Patients Should Know
If you use insulin, look into the $35-a-month cap programs offered by the manufacturers and, if eligible, Medicare’s copay cap, plus manufacturer patient-assistance programs — these can cut costs now regardless of the litigation. The lawsuits are brought largely by governments rather than through an individual claims website, so be wary of ads implying a personal payout is available.
Before You Act
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Insulin Pricing Lawsuit: The Overpricing Scheme Claims: Frequently Asked Questions
Answers to the most common questions about this case and your legal options.
What is the insulin pricing lawsuit about?
States and others allege the three big insulin makers (Lilly, Novo Nordisk, Sanofi) and the largest PBMs (CVS Caremark, Express Scripts, OptumRx) schemed to inflate insulin's list price while trading large rebates, leaving many patients to overpay. Claims invoke consumer-protection and RICO laws.
Is there an insulin pricing settlement?
Not a global one. The federal cases are consolidated in an MDL in New Jersey and are being contested. Separately, manufacturers adopted voluntary $35 monthly caps and federal law caps Medicare insulin copays — steps distinct from the lawsuits.
How can I lower my insulin costs now?
Look into the manufacturers' $35-a-month cap programs, Medicare's copay cap if eligible, and patient-assistance programs, which can reduce costs regardless of the litigation.
Legal Disclaimer
This article is general legal information, not legal advice, and does not create an attorney-client relationship. Case status, eligibility criteria, and any amounts described are as reported at the date shown and may change. Consult a licensed attorney in your jurisdiction about your own situation.