Arkansas sues PBMs Optum, Express Scripts over opioid crisis

Arkansas Attorney General Tim Griffin has announced that the state is taking legal action against pharmacy benefit managers (PBMs) Optum and Express Scripts due to their involvement in the state's worsening opioid crisis. The lawsuit claims these companies, which handle prescription drug benefits for health plans, financially benefited from their dealings with opioid manufacturers and did not adequately protect consumers from the epidemic.

According to the lawsuit, PBMs like Optum and Express Scripts facilitated the opioid crisis by negotiating favorable deals with opioid manufacturers and taking advantage of rebates. They are accused of placing opioid medications on the lower tiers of their formularies, making them more accessible despite known safety risks. These PBMs also operated online pharmacies that dispensed large quantities of opioids without addressing the growing epidemic.

The state asserts that both Optum and Express Scripts played significant roles as "gatekeepers" in the prescribing, fulfillment, and distribution of opioids across the nation, including Arkansas. The lawsuit highlights that these companies ignored the epidemic's severity, continuing their operations and reaping substantial profits. Notably, Optum is owned by UnitedHealth Group, and Express Scripts is a subsidiary of Cigna. Arkansas claims these corporations have used their profits from opioid sales to become enormous, vertically-integrated entities, each generating over $100 billion in annual revenue in recent years.

The lawsuit also points out specific instances of alleged collusion. For example, Optum and Express Scripts are accused of working with Purdue Pharma and other manufacturers to remove measures that would have limited opioid use. The complaint states that OptumInsight, part of UnitedHealth Group, received tens of millions of dollars from opioid manufacturers to help expand the opioid market.

This legal action is part of a broader scrutiny of PBMs by regulators and lawmakers. PBMs are also facing pressure from pharmacies over controversial fees. The National Community Pharmacists Association is investigating direct and indirect remuneration fees, which they believe violate antitrust laws.

In recent years, several healthcare and pharmaceutical companies have settled opioid-related lawsuits. Notably, Rite Aid has closed numerous stores amid bankruptcy and lawsuits related to the opioid crisis. Walgreens agreed to substantial settlements this year, paying $230 million to San Francisco and $500 million to New Mexico.

The opioid crisis has had a devastating impact on public health and the economy. The Centers for Disease Control and Prevention (CDC) reported that prescription opioid misuse cost the U.S. healthcare system nearly $1.5 trillion in 2020. Over 100,000 people died from overdose in both 2021 and 2022, with many turning to other addictive substances like heroin.

In Arkansas alone, the situation has worsened dramatically. In 2020, 546 people died from overdoses, marking a 350% increase since 2000. The state has also seen a rise in infants born with neonatal abstinence syndrome, a condition resulting from opioid exposure during pregnancy.

This lawsuit represents a critical step by Arkansas to hold PBMs accountable for their alleged role in the opioid crisis, which has deeply affected the state and its residents. The outcome could have significant implications for how PBMs operate and are regulated in the future.