“Arkansas Attorney General Tim Griffin is suing two national pharmacy benefit managers — Optum, Inc. and Express Scripts, Inc. — for their alleged roles in the opioid epidemic in Arkansas.
Griffin announced the lawsuit at a press conference Monday morning. The complaint, filed in Pulaski County Circuit Court, can be read here.
Pharmacy benefit managers, or PBMs, are companies that negotiate drug prices and administer prescription drug benefits on behalf of insurance plans. They act as middlemen between drug manufacturers, insurance companies, and pharmacies. Express Scripts and Optum are two of the largest PBMs in the country. They and a third company, CVS Caremark, handled nearly 80% of all prescription claims in the U.S. in 2023, according to Becker’s Hospital Review.
“This suit is based on a number of causes of action including public nuisance, negligence and unjust enrichment,” Griffin said Monday. In a press release, he accused Optum and Express Scripts of the following:
- Fueled the opioid epidemic in Arkansas by increasing opioid utilization by placing opioids on lower tiers of their formularies, controlling what less addictive pain treatments were available to patients, and falsely representing that their formularies were designed to be cost effective and achieve favorable health outcomes but instead were designed to maximize profits;
- Operated online retail pharmacies that dispensed billions of morphine milligram equivalents of opioids while failing to follow state and federal laws on controlled substances; and,
- Were aware of the opioid epidemic in Arkansas and failed to take any action.
Griffin said the PBMs “were acting in a way that prioritized maintaining their profits over prioritizing what they could have been doing to ameliorate the crisis that was ongoing here in Arkansas and around the country.”
State and local governments, including Arkansas, have previously sued companies that have manufactured, distributed and sold opioids, resulting in billions of dollars in settlements. According to KFF Health News, Arkansas has received almost $54.6 million in payments related to opioid settlements in recent years and is expected to receive an estimated $166 million in the future. Los Angeles County and the city of Boston have also filed opioid-related lawsuits in the past year that named Express Scripts and Optum as defendants.
While pharmacy benefit managers haven’t been part of past litigation related to the opioid crisis in Arkansas, this isn’t the first time the state has tangled with PBMs. In 2015, Arkansas passed a law requiring PBMs to reimburse Arkansas pharmacies at a price equal to or higher than the wholesale cost of drugs. A PBM trade association sued the state, and in 2020 the U.S. Supreme Court upheld the Arkansas law.
In 2022, then-Attorney General Leslie Rutledge named several PBMs, including Optum and Express Scripts, in a lawsuit against several pharmaceutical companies and PBMs over the high price of insulin.”