What is the bottom line on the insulin market?
Insulin became the defining case of rising costs for an old drug without new benefits — investigations, list-price cuts, FTC reforms and the Medicare $35 cap have delivered real relief, but states are still pursuing past damages and Florida's suit signals GLP-1 drugs are the next front.
Insulin became the defining example of how the US drug pricing system can produce rising costs for an old medicine without new benefits. Investigations found manufacturers raised prices in parallel, PBMs rewarded high list prices with higher rebates and fees, and patients who paid based on list price bore the burden. Since 2023, list price cuts, the Medicare $35 cap, state settlements and FTC reforms have reduced patient costs significantly. But the litigation is far from over: state suits and the MDL seek damages for past harm, and Florida's lawsuit suggests states will apply the same theory to GLP-1 drugs. Both manufacturers and PBMs deny wrongdoing and blame each other. Florida's lawsuit suggests many see the newer GLP-1 diabetes and obesity drugs as the next front in this fight.