FRANKFORT, Ky. — The Attorney General of Kentucky has broadened an ongoing lawsuit related to opioid abuse by including a major pharmacy benefit manager, alleging that it played a role in fueling the state’s growing addiction crisis.
Attorney General Russell Coleman announced on Tuesday that OptumRx has been added as a defendant in the lawsuit, which was initially filed two months prior. The accusations against OptumRx mirror those made against Express Scripts, which continues to be a defendant in the suit.
Coleman, a member of the Republican Party, charged Optum with contributing significantly to what he characterized as the irresponsible promotion and distribution of opioids. According to the lawsuit, OptumRx manages a pharmacy network that includes around 67,000 retail locations across the country.
Kentucky has been severely impacted by the opioid addiction crisis, suffering from some of the highest overdose death rates in the nation. “These groups have pursued a profit-driven agenda that has come at the significant cost to Kentucky families, leaving them with empty chairs at the dinner table,” stated Coleman in a press release.
As of Tuesday, Optum had not provided a public response to requests for comments. When Express Scripts was initially named in the lawsuit, a representative emphasized the company’s commitment to combating opioid abuse and expressed intentions to “vigorously contest these unfounded claims in court.”
Coleman initiated the legal proceedings in a state court, but there has been contention between the involved parties regarding whether the case should be heard in state or federal court. The attorney general is advocating for the case to remain in state jurisdiction.
The lawsuit accuses the defendants of utilizing misleading marketing strategies to drive sales of highly addictive substances. Furthermore, it alleges that they distributed opioids through mail-order pharmacies without appropriate regulatory controls, violating both state and federal laws.
Among other requests, Coleman is asking for civil penalties for each intentional breach of the Kentucky Consumer Protection Act, in addition to other remedies that the court considers suitable. The lawsuit claims that the defendants have concealed their misconduct through opaque business practices and enforced confidentiality agreements with other entities involved, such as opioid manufacturers.
Pharmacy benefit managers (PBMs) are responsible for managing prescription drug benefits for health insurers and the employers that offer coverage. They play a crucial role in determining which medications are included on a plan’s formulary—the list of drugs covered by the insurance—and influence the pharmacy options available to patients.
Over the years, PBMs have faced criticism from politicians and consumers. However, PBMs argue that they are essential in managing drug costs and claim to pass on most of the negotiated discounts to their clients.
Legal actions against pharmacy benefit managers represent the latest chapter in a long history of litigation related to the opioid epidemic in the United States. Manufacturers, distributors, and pharmacy chains have already confronted numerous lawsuits—many of which have been settled—requiring that funds be allocated to address the challenges of overdose and addiction.
The rise in overdose deaths began in the 1990s due to opioid painkillers, followed by increasing fatalities from other opioids like heroin and more recently, illicit fentanyl. There are indications that the number of drug overdose deaths in the United States has continued to decrease this year, leading experts to believe that meaningful progress may be being made in combatting this persistent crisis.
In Kentucky, drug overdose deaths decreased by nearly 10% in 2023, marking the second consecutive year of decline. Despite this encouraging trend, state officials warn that overdose fatalities remain unacceptably high, underscoring that the battle against the drug crisis is ongoing. Nearly 2,000 residents in Kentucky lost their lives to drug overdoses in the previous year.
