Why does the gap between list price and net price matter to patients?
Florida's AG alleges Lilly returns ~$210 of every $280 Humalog vial as rebates and discounts — 75% of sticker price — while uninsured, underinsured and high-deductible patients pay the list figure, a gap that killed 26-year-old Alec Smith when he rationed insulin he could not afford.
Rebates are paid after the pharmacy sale, so patients paying cash, or paying a deductible or coinsurance based on list price, pay the inflated figure even when their plan ultimately pays much less. Florida's attorney general alleges that Lilly returns about $210 of every $280 Humalog vial to PBMs as rebates and discounts, about 75% of the sticker price, while the list price remains what many patients see at the counter. California's complaint made the same point: the list price visible to patients could be much higher than the amount ultimately paid after rebates, hitting the uninsured, underinsured and those on high-deductible plans hardest. The human cost became a national story through cases such as Alec Smith, a 26-year-old who died after rationing insulin he could not afford.