Texas attorney general sues Eli Lilly over Mounjaro and Zepbound prescribing inducements

Texas Attorney General Ken Paxton, joined by co-plaintiff Health Choice Alliance, sued Eli Lilly on August 11, 2025, in the 71st Judicial District Court in Harrison County. The suit alleges that two Lilly programs amounted to illegal kickbacks that improperly steered doctors toward prescribing Mounjaro and Zepbound, along with several other Lilly drugs ^[1][2].

The lawsuit names two specific arrangements. The first, called the "Free Nurse Program," allegedly gave providers free patient-care services, either directly from Lilly or through third parties, described in the filing as "in-kind remuneration" ^[2]. The second, the "Support Services Program," allegedly offered providers reimbursement support services that the state characterizes as kickbacks ^[2]. Paxton's office says these inducements caused millions of dollars in Texas Medicaid claims to be "tainted by Eli Lilly's illegal marketing and quid pro quo arrangements," in violation of the Texas Health Care Program Fraud Prevention Act ^[1]. Texas is seeking more than $1 million in damages, civil penalties, and an injunction ^[1].

Beyond Mounjaro and Zepbound, the complaint also points to alleged inducements tied to other Lilly products, including the Type 1 diabetes drug Basaglar, the eczema treatment Ebglyss, the migraine drug Emgality, several insulin products, and the inflammatory drug Taltz ^[2]. "Big Pharma compromised medical decision-making by engaging in an illegal kickback scheme," Paxton said, adding that Lilly "fraudulently sought to maximize profits at taxpayer expense" ^[1].

Eli Lilly disputes the claims. A company spokesperson said Lilly will "vigorously defend against these allegations" and noted that "multiple courts and the federal government have rejected claims by this same corporate relator against Lilly as meritless" ^[2]. That history matters: Health Choice Alliance first sued Lilly in 2017 over an alleged kickback scheme involving free nursing services tied to Humalog, Humulin and the osteoporosis drug Forteo. A federal judge in Texas dismissed that case in 2018 for lacking sufficient factual detail, and the Fifth Circuit Court of Appeals upheld the dismissal in 2021 ^[2]. Lilly's spokesperson also cited a prior government finding that the relator's allegations "lack sufficient factual and legal support," and noted the government's view that federal health programs have a legitimate interest in ensuring patients get "basic product support relating to their medication" after a prescription is written ^[2].

This case follows an earlier Texas lawsuit filed last October against Lilly, Novo Nordisk, Sanofi, and several pharmacy benefit managers over alleged price-fixing arrangements involving insulin products ^[2].

Why it matters for patients

This lawsuit is about how Mounjaro and Zepbound get prescribed and paid for, not about whether the drugs work or are safe. Patients taking these medications through Texas Medicaid are not being asked to do anything differently right now; the case targets Lilly's marketing and support-service arrangements with providers, not patients' prescriptions directly ^[1][2].

The outcome could still matter to patients over time. If courts find that support programs tied to prescriptions functioned as illegal inducements, that could affect how manufacturers structure nurse support or reimbursement assistance programs going forward, potentially changing what kind of help patients receive when starting these drugs. Given that similar allegations from the same plaintiff were previously dismissed in federal court and rejected by the government, it is not yet known whether this state-court case will produce a different result ^[2].

What happens next

No trial date, hearing schedule, or Lilly response deadline is available in the sources reviewed. Lilly has said it will contest the allegations, but further procedural developments, such as a formal answer or motion to dismiss, are not yet reported ^[1][2][3].