Arkansas Attorney General Tim Griffin revealed the state is filing a lawsuit against pharmacy benefit managers (PBMs) Optum and Express Scripts for their role in the state's ongoing opioid epidemic.
In the lawsuit (PDF), the state argues the PBMs negotiated deals with opioid manufacturers and exploited rebates, all while failing to protect consumers as they financially benefited.
“Pill by pill and dollar by dollar, PBMs enabled the opioid epidemic in Arkansas,” said Griffin in a statement June 24. “Today, we begin the process of holding them accountable for their roles in a crisis that has ravaged our state—a crisis they helped cause, contributed to and furthered.”
Optum and Express Scripts did not reply to requests for comment.
“This case arises from Defendant Optum’s and Defendant Express Scripts’s role in causing and furthering the worst man-made epidemic in modern medical history: the misuse, abuse, diversion and over-prescription of opioids,” the lawsuit begins. “Defendants quite literally serve as gatekeepers to the prescribing, fulfilling and dispensing of opioids throughout the nation, including Arkansas.”
The lawsuit alleges PBMs place opioid drugs on the lower tiers of its formularies, forgoing safety concerns.
Additionally, the PBMs operated online retail pharmacies that unleashed “billions of morphine milligram equivalents of opioids” but did not take action against an epidemic they knew existed, the state wrote in the lawsuit. For example, Optum and Express Scripts are accused of colluding with Purdue Pharma and other manufacturers to remove utilization management measures.
Optum is owned by UnitedHealth Group, while Express Scripts is owned by Cigna. Arkansas alleged that these companies used the immense profits earned from opioid sales to grow into “vertically-integrated colossuses” and noted both companies have exceeded $100 billion in annual revenue in recent years.
“Opioid manufacturers had dedicated executives assigned to expand and strengthen the ties between UHG, OptumInsight, OptumRx and the manufacturers," the lawsuit said. “OptumInsight was paid tens of millions of dollars by opioid manufacturers for its work to expand the opioid market.”
In 2021, Centene was forced to pay $15.2 million to Arkansas after a PBM subsidiary submitted inaccurate bills and didn’t disclose discounts.
PBMs, under a huge spotlight from regulators and lawmakers, are also under pressure from pharmacies over controversial fees. The National Community Pharmacists Association announced in October it is investigating direct and indirect remuneration fees for community pharmacies. The group maintains those fees are an antitrust violation.
Healthcare and pharma companies have resolved opioid lawsuits in recent years. Rite Aid has closed hundreds of stores since filing for bankruptcy in October. The business faces numerous lawsuits for its alleged role in the opioid crisis.
Walgreens agreed to pay $230 million to San Francisco in May 2023. The city’s attorney said from 2006 to 2014, there were more than 163 million opioid pills distributed. The company then agreed to pay $500 million to New Mexico the following month, on the same day CVS agreed to a settlement with California.
The Centers for Disease Control and Prevention previously said prescription opioid misuse cost the U.S. healthcare system almost $1.5 trillion in 2020. More than 100,000 people died due to an overdose dose in both 2021 and 2022, while other users began taking addictive drugs like heroin.
In Arkansas, 546 people died due to overdoses in 2020, a 350% increase from the year 2000. Infants born with neonatal abstinence syndrome are also on the rise, the lawsuit said.