About 1.3 million Pennsylvanians live with diabetes, and many of them rely on insulin every day. On October 13, 2026, Pennsylvania Attorney General Dave Sunday announced that his office had sued the three companies that make most of the country’s insulin and the three biggest “pharmacy benefit managers” (PBMs), accusing them of working together to push insulin prices far above what the drugs cost to make.

The complaint was filed in the Commonwealth Court of Pennsylvania by the Attorney General’s Antitrust Section. It relies mainly on Pennsylvania’s consumer protection statute, the Unfair Trade Practices and Consumer Protection Law (UTPCPL), and also claims unjust enrichment and civil conspiracy. These are allegations. No court has found any of the companies liable.

Who is being sued

• The manufacturers: Eli Lilly and Company, Novo Nordisk Inc. and Sanofi-Aventis U.S. LLC.
• The PBMs: CVS Caremark, Express Scripts (including its parent Evernorth) and OptumRx, along with related corporate entities, including CVS Health Corporation and UnitedHealth Group.

PBMs are the middlemen that manage prescription drug benefits for health insurers, employers and government plans. According to the complaint, these three PBMs control roughly 80% of the PBM market, run some of the largest pharmacies in the country, and are owned by or affiliated with three of the largest health insurers: Cigna, Aetna and UnitedHealth Group.

What the lawsuit claims

The Attorney General calls the alleged conduct the “Insulin Pricing Scheme.” According to the complaint, it works like this:

1. The manufacturers raise their list prices to win a good spot on the PBMs’ formularies, the lists that decide which drugs your insurance covers and what you pay for them.
2. The manufacturers then pay a large, undisclosed share of that list price back to the PBMs as rebates, fees and other “manufacturer payments.”
3. The PBMs give preferred formulary status to the drugs with the biggest payments and the highest list prices. Starting around 2012, they also used “exclusionary” formularies that leave some lower-priced options off the list entirely.
4. The PBMs keep a significant share of those payments instead of passing the savings to patients and health plans.

The complaint says diabetes drugs that cost the manufacturers less than $2 to produce, and were first priced around $20 in the late 1990s, rose to between $300 and $700. It says the list prices of some insulins have climbed by more than 1,000% since 2003. The examples it gives include Eli Lilly’s Humulin R (500U/mL), which went from $200 to $1,784 a vial, and Novo Nordisk’s Novolog pens, which went from $108 to $671 a package. The lawsuit also covers newer Type 2 drugs, including GLP-1 medications such as Ozempic and Mounjaro, which it says sell for nearly $1,000 a month.

Why list prices hurt patients even with insurance

Rebates paid behind the scenes don’t lower what you pay at the counter. The complaint points out that uninsured patients pay the full price every time they fill a prescription. It says nearly 750,000 Pennsylvanians are uninsured. Insured patients are often hit too, because deductibles and coinsurance are usually calculated from the inflated list price, not the lower net price the PBM actually negotiated. Citing national data, the complaint says that during those years about one in four diabetics skimped on or skipped doses because of cost.

What Pennsylvania is asking for

• A permanent injunction, including structural changes meant to bring prices down to fair market levels and open up options for patients.
• Restitution for Pennsylvanians who were harmed, plus disgorgement of money gained through the alleged violations.
• Civil penalties under the UTPCPL of $1,000 per violation, rising to $3,000 per violation when the victim is 60 or older.
• Costs, and a jury trial.

The case has only just been filed. The companies will have a chance to respond, and lawsuits like this often take years. Any money for consumers would come only through a court judgment or a settlement, and no claims process exists right now. If one is created, it will be announced by the Attorney General’s office.

What this means for you now

• If you’re on Medicare, federal law already caps your cost for each covered insulin at $35 for a one-month supply under Part D and Part B, and the Part D cap applies whether or not you get Extra Help.
• If you’re uninsured or have a high-deductible plan, ask your doctor or pharmacist about manufacturer savings programs and lower-cost options. Don’t ration insulin without talking to your doctor.
• Keep your receipts and pharmacy records. If restitution becomes available, records of what you paid out of pocket, and when, may matter.
• Report problems. Pennsylvanians can file a consumer complaint with the Attorney General’s Bureau of Consumer Protection online.
• Know your own rights under the UTPCPL. Besides the Attorney General’s enforcement power, the law lets individuals who bought goods or services and suffered an ascertainable loss because of deceptive conduct bring their own lawsuits. Whether that applies to you depends on your facts.

The bigger picture

This lawsuit fits a growing pattern: state attorneys general using consumer protection laws to go after pricing practices that ordinary shoppers can’t see, from hidden fees to algorithm-driven prices. Pennsylvania’s UTPCPL is one of the broadest of these laws. It reaches “unfair or deceptive acts or practices” in any trade or commerce, and its higher civil penalties for harm to people 60 and older are an important protection for seniors.

Ginsburg Law Group represents consumers in Pennsylvania and other states against unfair and deceptive business practices. If you believe a company misled you about prices, fees or what you were buying, contact us for a review of your situation.

This article is for general informational purposes only and is not legal advice. The Commonwealth’s lawsuit contains allegations that have not been proven, and the defendants have not been found liable. Consult a licensed attorney about your specific situation, and talk to your doctor before making any change to your medication.

Authoritative Sources

• Pennsylvania Office of Attorney General: AG Sunday’s Antitrust Section Takes Action Against Insulin Makers, PBMs for Pricing Scheme (Oct. 13, 2026)
• Complaint, Commonwealth of Pennsylvania v. Eli Lilly and Company, et al. (Pa. Commw. Ct.)
• Medicare.gov: Insulin coverage and the $35 monthly cap
• Pennsylvania Office of Attorney General: File a Consumer Complaint