# Sanofi French pharmaceutical multinational (Paris; assembled through decades of mergers, Sanofi-Aventis until 2011) — the third member of the U.S. insulin cartel alongside [[Eli Lilly]] and [[Novo Nordisk]], and one of the world's largest vaccine manufacturers, supplying a major share of U.S. flu vaccines. Its presence completes the cartel picture: three companies, three countries (U.S., Denmark, France), one synchronized U.S. pricing pattern. ## The Insulin Record Sanofi's long-acting insulin Lantus was for years the largest-selling insulin in the world, and its U.S. list price climbed in the same near-lockstep pattern documented across the cartel — the parallel escalation at the heart of the class-action litigation and congressional investigations of the 2017–2021 period. The unraveling came in 2023: after the [[Inflation Reduction Act]] capped Medicare insulin copays at $35 and Lilly broke ranks with deep list-price cuts, Sanofi followed with cuts of up to 78% on Lantus plus its own $35 out-of-pocket cap — a coordinated-looking retreat that mirrored the coordinated-looking climb. ## The MFN Deal Sanofi joined the [[Most-Favored-Nation Drug Pricing Deals]] in the December 2025 cohort. Per its own announcement, the "voluntary, confidential" agreement gives state Medicaid programs MFN prices (average cuts of 61% on certain diabetes, cardiovascular, neurological, and cancer medicines), routes discounts averaging ~70% through TrumpRx.gov including insulins, and — the operative clause for a French manufacturer — establishes a **tariff-free accord** shielding it from the administration's [[Section 232]] pharmaceutical tariffs. As with the rest of the cohort, the confidentiality means the claimed discounts are unverifiable against actual net prices. As a top vaccine maker, Sanofi also sits in the blast radius of [[MAHA]] vaccine policy — shifting ACIP recommendations and FDA restrictions hit its core franchise — making it, like [[Pfizer]], a company simultaneously dealt with on price and besieged on product. ## Connections - [[Eli Lilly]] / [[Novo Nordisk]] — Fellow insulin-cartel members - [[Big Pharma]] — Hub; insulin cartel analysis - [[Most-Favored-Nation Drug Pricing Deals]] — December 2025 signatory - [[Inflation Reduction Act]] — The $35 cap that broke the pricing pattern - [[MAHA]] — Vaccine-franchise exposure