Pennsylvania sues 19 companies over alleged insulin pricing

Pennsylvania has filed a civil lawsuit against 19 companies, alleging that arrangements between insulin manufacturers and pharmacy-benefit managers helped inflate prices for insulin and other diabetes medications. The complaint seeks changes to the companies’ practices and monetary relief. Its allegations have not been decided by a court.

The state’s Antitrust Section filed the complaint in Commonwealth Court on Oct. 9, 2026, according to PhillyVoice. The Pennsylvania Attorney General’s Office announced the lawsuit on Oct. 13. The defendants are three manufacturers — Eli Lilly, Novo Nordisk and Sanofi — and 16 pharmacy-benefit-manager companies or affiliates associated with Express Scripts, CVS Caremark and Optum.

The state’s allegations about prices and coverage

The complaint alleges that manufacturers raised drug prices and paid pharmacy benefit managers, commonly called PBMs, for favorable placement on drug formularies. Formularies determine which medicines receive preferred coverage. The state says PBMs retained payments and excluded some lower-priced alternatives, practices it alleges raised costs and restricted access.

Pennsylvania asserts claims under the state’s Unfair Trade Practices and Consumer Protection Law, as well as claims of unjust enrichment and civil conspiracy. These are allegations in the complaint, not findings that the companies coordinated their conduct or violated the law.

The complaint alleges that prices for the medications at issue rose from about $20 to between $300 and $700 or more. It also alleges that the conduct inflated insulin prices by more than 1,000%. The state’s filing presents those figures as part of its case; they have not been established as findings in this litigation.

The complaint also alleges that three PBM groups control about 80% of the PBM market. That market-share figure is another assertion by the state, not a court determination.

Pennsylvania identifies patients and payors who purchased the medications as people potentially harmed by the alleged practices. The Attorney General’s Office and complaint cite estimates of about 1.3 million state residents living with diabetes and 3.5 million with prediabetes, along with $16.4 billion in annual Pennsylvania costs associated with diagnosed diabetes. Those figures describe the scale of diabetes and its estimated costs in the state; they do not show how many people used the medicines at issue or were harmed by the alleged conduct.

Relief sought in Commonwealth Court

The state asks the court to order changes to the defendants’ practices and seeks restitution or statutory disgorgement, civil penalties, costs and other equitable relief. None of those remedies has been granted. The complaint itself does not lower drug prices, change insurance coverage or alter access to insulin.

The case remains unresolved, and no ruling establishing liability or granting relief is identified. The defendants must respond after service of the complaint. The lawsuit puts the state’s claims before the court, but whether Pennsylvania can prove them — and whether patients or payors will receive any remedy — remains to be decided.