Texas sues Eli Lilly, alleging kickbacks led prescribers to Mounjaro and Zepbound

On Aug. 12, 2025, Texas Attorney General Ken Paxton and the group Health Choice Alliance filed suit against Eli Lilly, alleging the Indianapolis drugmaker rewarded medical providers for writing prescriptions for its products — a list that includes Mounjaro and Zepbound, both brand names for tirzepatide ^[1].

The complaint, described in a release from Paxton's office, accuses Lilly of handing out "illegal incentives" so providers would prescribe its medicines. Because many of those products were paid for by Medicaid, the plaintiffs argue, millions of dollars in state claims became "tainted by Eli Lilly's illegal marketing and quid pro quo arrangements" ^[1].

Paxton framed the allegation bluntly: "Big Pharma compromised medical decision-making by engaging in an illegal kickback scheme," he said. "I will not stand by while corporations unlawfully manipulate our healthcare system to line their own pockets" ^[1].

The two alleged programs

The filing names two arrangements. One it calls the "Free Nurse Program," in which Lilly is accused of supplying free patient-care services — itself or through other parties — described in the suit as "in-kind remuneration to providers." The other, the "Support Services Program," allegedly delivered kickbacks in the form of reimbursement support ^[1].

Mounjaro and Zepbound are not the only products named. The suit says the same conduct was used to drive prescriptions for Basaglar, an insulin for Type 1 diabetes; Ebglyss for eczema; Emgality for migraine; Taltz for inflammatory conditions; and several insulin presentations, among other approved medicines ^[1].

Lilly's position

A Lilly spokesperson said the company will "vigorously defend against these allegations," and added that "multiple courts and the federal government have rejected claims by this same corporate relator against Lilly as meritless" — a reference to Health Choice Alliance ^[1].

The spokesperson also cited a prior federal determination that "the relators' allegations lack sufficient factual and legal support," and pointed to the government's stated interest in making sure patients "have access to basic product support relating to their medication" once a physician has appropriately prescribed it ^[1].

Health Choice Alliance has brought similar claims before. Its 2017 suit accused Lilly of a "multi-tiered kickback scheme" involving free nursing services in exchange for prescriptions of Humalog, Humulin and the osteoporosis drug Forteo. A federal judge in Texas threw the case out in August 2018, saying the facts were not specific enough, and the Fifth Circuit Court of Appeals affirmed that outcome in 2021 ^[1].

Why it matters for patients

Nothing in the suit alleges that Mounjaro, Zepbound or the other drugs named are unsafe or ineffective. The dispute is over marketing and what Lilly allegedly provided to prescribers; the medicines' regulatory approvals are not being challenged ^[1].

For Texans on Medicaid, the "tainted" claims refer to money the state program spent — not to any individual's eligibility, copay or coverage, which the filing does not change. Nor does it alter what a prescriber is permitted to prescribe ^[1].

The practical question at the center of the case is whether payments or services from a manufacturer can influence which medicine a patient ends up being offered. That is the conduct the attorney general calls illegal. Lilly disputes it ^[1].

What happens next

Lilly says it will fight the case. No hearing dates, trial schedule or resolution timeline have been reported ^[1]. For scale, the earlier Health Choice Alliance matter ran about four years, from its 2017 filing to the 2021 appellate ruling ^[1].

Texas is separately pursuing a case filed in October 2024 that accuses Lilly, Novo Nordisk, Sanofi and several pharmacy benefit managers of inflating insulin prices and paying undisclosed sums back to those middlemen ^[1].