Arkansas sues Optum, Express Scripts and others over opioid epidemic
The action of PBMs, combined with those of manufacturers, distributors and pharmacies created the opioid crisis, lawsuit says.
Photo: Kinga Krzeminska/Getty Images
The state of Arkansas is suing Optum, OptumRx and parent company UnitedHealth Group, Cigna's Evernorth and its pharmacy benefit manager Express Scripts, and others over the opioid epidemic.
The complaint was filed June 24 in the Circuit Court of Pulaski County, Arkansas.
Attorney General Tim Griffin wants the actions of the Optum and other defendants decreed illegal and as failing to comply with state law requiring the monitoring and reporting of suspicious opioid distribution to Arkansas and surrounding areas.
The state wants restitution of an unspecified amount, costs and expenses and a jury trial.
WHY THIS MATTERS
The action is against PBMs as middlemen who determine rebates and formulary placement. PBMs provide services to prescription drug benefit plans sponsored by health insurers, self-insured employers, and state and federal government agencies.
The state blames PBMs for putting profits over patient safety and "in causing and furthering the worst man-made epidemic in modern medical history: the misuse, abuse, diversion, and over-prescription of opioids."
The opioid epidemic has killed thousands, created a healthcare crisis by flooding emergency rooms and behavioral health centers. It has also caused increases in foster care numbers and in the number infants born with neonatal abstinence syndrome, the complaint said.
As PBMs, the defendants are the only players to interact with health plans, drug manufacturers and pharmacies, the complaint said.
"Defendants quite literally serve as gatekeepers to the prescribing, fulfilling and dispensing of opioids throughout the nation, including Arkansas," the lawsuit said
Due to the actions of the PBMs, and also their inactions, opioid abuse has ravaged the state of Arkansas, the lawsuit said.
"Rather than consider factors like pre-approval or other consumer safety measures, PBMs focused mainly on rebates. As a result, PBMs benefited financially from the opioid crisis by negotiating favorable deals with opioid manufacturers and by not taking sufficient action to curb excessive opioid prescriptions as detailed herein," it said.
The action of PBMs, combined with those of manufacturers, distributors and pharmacies, created the opioid crisis that began in the 1990s, the complaint said.
As of 2023, OptumRx provided services to more than 67,000 retail pharmacies. In 2022, OptumRx managed $124 billion in pharmaceutical spending. OptumInsight worked directly with opioid manufacturers to create, provide, support and disseminate opioid manufacturers' marketing messages and in other ways, the complaint said.
Also, the AG said UHG's executives and officers are directly involved in the policies and business decisions of Optum, OptumRx and OptumInsight.
In 2018, Evernorth (then known as Express Scripts) merged with Cigna Corporation, a global health service company, in a $67 billion deal to consolidate their health insurance, PBM and mail-order pharmacy businesses.
THE LARGER TREND
In 2017, the Centers for Disease Control and Prevention estimated that prescription opioid misuse cost the United States $1.02 trillion, considering healthcare expenses, lost productivity, addiction treatment and criminal justice involvement, according to the complaint.
The United States Congressional Joint Economic Committee estimated that the opioid crisis cost the United States nearly $1.5 trillion in 2020, which is a 37% increase from 2017.
By 2020, the number of Americans who died because of opioid overdose was 93,655, and the death toll continued to rise in 2021, when there were an estimated 107,622 overdose deaths.
That is an almost 15% increase from the estimated overdose deaths in 2020. Overdose deaths again topped 100,000 in 2022, and overdose is now the leading cause of death for people under 50, the complaint said.
Many opioid users have turned to heroin, having become addicted to, but no longer able to obtain, prescription opioids, according to the complaint. The American Society of Addiction Medicine said 80% of people who began using heroin in the past decade started with prescription opioids – which, at the molecular level and in their effect, closely resemble heroin.
By 2016, Arkansas had the second-highest opioid prescribing rate in the nation, with 114.6 opioids being dispersed for every 100 Arkansans, nearly twofold greater than the U.S. average.
The CDC estimates 546 people died because of overdoses in Arkansas in 2020 – a rate of 19.1 deaths per 100,000 persons. This represents a 350% increase from a rate of 5.4 overdose deaths per 100,000 residents in 2000, just 17 years earlier.
Email the writer: SMorse@himss.org
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