$5,169 per signed retainer. The highest CPA in the top 10. And the case count just quintupled in 12 months.
Depo-Provera isn’t sneaking up on anyone. It’s the #2 hot tort in the country with a 9.8 score. Only social media addiction ranks higher.
3,335 cases in the MDL. 300+ filing per month. And the FDA just handed plaintiffs the one thing Pfizer was fighting hardest to prevent.
The FDA Reversal
December 12, 2025. The FDA approved Supplement 74, adding a meningioma warning to the Depo-Provera prescribing information.
That date matters more than any bellwether trial.
Pfizer’s entire defense strategy was built on preemption. Their argument: the FDA reviewed the data in 2024 and rejected a label change. State courts can’t override a federal agency’s determination. Case closed.
Then the FDA reversed itself. Eighteen months later.
The updated label reads: “Meningioma: Discontinue Depo-Provera CI if meningioma is diagnosed. Monitor patients for signs and symptoms of meningioma.”
Pfizer’s preemption defense didn’t just weaken. It collapsed. You can’t argue the FDA didn’t require a warning when the FDA now requires exactly that warning.
The MDL
MDL-3140 sits in the Northern District of Florida under Judge M. Casey Rodgers. Created February 2025. Over 3,335 federal cases pending, with roughly 4,000 total including state filings in Delaware, New York, and California.
The growth is staggering. From 400 cases at MDL creation to over 3,300 in 12 months. That’s a fivefold increase with no sign of slowing.
Five pilot cases are selected for bellwether: Toney, Blonski, Schmidt, Wilson, and Arceo. First trial: December 7, 2026.
Before that, the Daubert hearings on May 26-28. Those determine whether the BMJ and JAMA studies survive as admissible evidence. Given the FDA’s own label change, excluding the science would be difficult to justify.
The Science
Two studies form the causation backbone. Both are strong.
The BMJ French study (March 2024) analyzed 18,061 operated meningioma cases from France’s national health database. Finding: injectable medroxyprogesterone acetate users had a 5.55x increased odds of developing intracranial meningioma.
The JAMA Neurology study (November 2025) confirmed it in the US. Cleveland Clinic researchers analyzed 10.4 million women. Finding: 2.43x relative risk for Depo-Provera users. Risk concentrated in women with 4+ years of use and those who started after age 31.
A third study in Expert Opinion on Drug Safety found 3.5x greater risk compared to combination oral contraceptives.
Pfizer’s “it’s just a French study” defense died the moment JAMA published the US data. Then the FDA acted. The science isn’t disputed anymore. It’s on the label.
The Lead Economics
The most expensive leads in the top 10. Worth every dollar.
Whitehardt scores Depo-Provera at 9.8. CPL runs $3,050. CPA is $5,169 per signed retainer. Those numbers look brutal until you see the other side.
Projected settlements: $75,000-$150,000 for monitored meningiomas without surgery. $150,000-$500,000 for surgical cases. $500,000 to over $1 million for severe cases with craniotomy complications.
The MOIC math on a $5,169 CPA against a $250,000 mid-tier surgical case is 48:1. Even at the conservative floor, $75,000 on a monitored case, that’s 15:1.
Why are CPAs so high? Meningioma is the qualifying diagnosis. Not headaches. Not “symptoms.” A confirmed brain tumor diagnosed via MRI or CT scan. The screening bar filters out most inquiries before they reach intake.
Who’s Being Sued
Pfizer. That’s it.
Pfizer inherited Depo-Provera through the Pharmacia & Upjohn acquisition in 2003. They own the brand, the formulation, and the liability.
Their defense playbook has three moves. Preemption (weakened by the FDA label change). Daubert challenges on causation experts (difficult when the FDA validated the science). And arguing that generic manufacturers, not Pfizer, supplied the product in specific cases.
The generic distinction matters. Authorized generics manufactured by Pharmacia & Upjohn, Greenstone, A-S Medication Solutions, and Prasco are covered. Unauthorized generics aren’t. Firms need to verify which product the plaintiff used.
The Advertising Playbook
Digital-first. Not even close.
Meta is maxed out at 5.0 on the Whitehardt scale. The primary acquisition channel. The plaintiff demographic is women aged 25-55 who used hormonal contraception. Meta’s targeting infrastructure reaches them precisely.
PPC captures active searchers at 2.0 and growing. “Depo-Provera lawsuit” and “Depo-Provera brain tumor” keywords are heating up fast. The FDA’s December warning created a search demand spike that hasn’t cooled.
TV sits at 2.8 but isn’t driving direct response yet. Expect broadcast to ramp six months before the December bellwether. That’s the historical pattern: TV surges pre-trial, then either crashes or sustains depending on the verdict.
CTV is the underused channel at 15%. The plaintiff demographic over-indexes on ad-supported streaming. Household-level targeting lets you reach women in the right age range without the waste of linear broadcast. Attribution closes the loop.
The Plaintiff Pool
Twenty-five percent of American women aged 15-49 have used Depo-Provera at some point. That’s over 20 million women.
The racial disparity matters. Black women use Depo-Provera at 8.4%, nearly five times the rate of white women at 1.8%. The product was disproportionately prescribed to lower-income women, women of color, and women with mental health conditions.
That history creates a health equity narrative that amplifies media coverage. It also creates a targeted advertising opportunity. The demographic concentration means social and CTV targeting can reach the plaintiff pool with less waste than most mass torts.
With roughly 4,000 cases filed and tens of thousands of potential meningioma diagnoses attributable to DMPA exposure, this litigation is in early innings of plaintiff identification.
Qualification Criteria
The screening bar is specific. Used brand-name Depo-Provera or an authorized generic. Minimum two injections.
Diagnosed with intracranial meningioma after starting Depo-Provera. Minimum two-year latency between first injection and diagnosis.
Born before 1990. Biological female. Injections received in the United States after 1992.
Geographic exclusions vary by firm but commonly include Alabama, Louisiana, Kentucky, Tennessee, Texas, and Mississippi due to tort reform or statute of limitations challenges.
Not currently represented. Valid US SSN. Statute of limitations checked by state.
The strongest cases: four or more years of use, craniotomy surgery, permanent neurological damage, multiple tumors. Those are the $500,000+ cases.
The Play
Depo-Provera is in the acquisition window right now. Four things determine what happens next.
First, the Daubert hearings in May. If the BMJ and JAMA studies survive as admissible evidence, the path to trial is clear. If they don’t, the tort stalls. The FDA’s own label change makes exclusion unlikely but not impossible.
Second, the preemption ruling. Pfizer’s strongest legal defense got gutted by the FDA reversal. Judge Rodgers hasn’t ruled yet. When she does, it’ll signal whether Pfizer has any remaining path to mass dismissal.
Third, December 7. The first bellwether trial. A plaintiff verdict with significant damages creates settlement pressure across the entire MDL. Pfizer has never faced a Depo-Provera jury. Nobody knows how it plays.
Fourth, this tort rewards digital-first firms. The $5,169 CPA is a barrier to entry that keeps low-budget lead gen out of the market. Firms with Meta targeting infrastructure and proper intake screening are building portfolios of cases worth $150,000-$1,000,000 each.
The firms winning Depo-Provera cases aren’t waiting for the bellwether. They’re acquiring now, at scale, because the science is on the label and the economics work at every tier.
References
- In Re: Depo-Provera (Depot Medroxyprogesterone Acetate) Products Liability Litigation, MDL No. 3140, N.D. Florida
- Roland N, et al. Use of progestogens and the risk of intracranial meningioma: a national case-control study. BMJ. 2024;384:e078078
- JAMA Neurology. Association of Depo-Provera with Meningioma Risk in US Women, Cleveland Clinic Study, November 2025
- FDA Supplemental Approval 74: Meningioma Warning Added to Depo-Provera Prescribing Information, December 12, 2025
- Whitehardt Mass Tort Report: Hot Tort Rankings and Lead Economics, Q1 2026