.png)
Michigan Attorney General Dana Nessel recently filed a lawsuit against OptumRX and Express Scripts, two of the largest pharmacy benefit managers (PBMs) in the country, accusing them of contributing to the opioid crisis in Michigan. The lawsuit, filed in Wayne County Circuit Court, alleges that the PBMs negotiated financially beneficial deals with opioid manufacturers, accepting kickbacks to promote the opioids on formularies, thus increasing their accessibility. Nessel claims that this practice led to widespread opioid misuse and addiction in the state, violating public nuisance laws, engaging in negligence, and breaching the Drug Dealer Liability Act by marketing a controlled substance in a manner that harmed Michigan residents struggling with addiction.
A Brief History of Legal Battles Over the Opioid Crisis
This case against PBMs marks a new direction in opioid-related litigation. Traditionally, lawsuits have targeted manufacturers, distributors, and retailers in the supply chain, with highly publicized cases and settlements that have reshaped the industry. For instance, major pharmacies like Rite Aid and CVS faced lawsuits and criticism for insufficiently controlling opioid dispensing practices. In some cases, such as with Purdue Pharma, the company was ordered to pay billions for its role in the crisis, partly due to its aggressive marketing of OxyContin. Purdue’s story even led to popular media adaptations, including documentaries and series like Dopesick, showcasing the scale of the crisis and its effects on individual lives.
Numerous physicians have also faced charges for overprescribing opioids. For example, Dr. Michael Swango was notorious for overprescribing controlled substances, and his practices were widely covered in news and legal reports as part of a broader indictment of medical professionals who fueled the crisis through negligence or profit-seeking. In another instance, Dr. Richard P. Sackler of Purdue Pharma was accused of directly influencing aggressive opioid sales strategies, adding to public outrage.
Holding PBMs Accountable: A New Approach
Unlike the manufacturers and prescribers previously held accountable, this lawsuit seeks to establish liability among PBMs, companies usually considered as intermediaries between insurers, manufacturers, and pharmacies. PBMs play a significant role in determining which medications receive favorable insurance terms, affecting pricing and access on a wide scale. This lawsuit could set a precedent if successful, emphasizing accountability across all levels of the pharmaceutical supply chain and potentially leading other states to pursue similar actions against PBMs.
By targeting PBMs like OptumRX and Express Scripts, Michigan is exploring a fresh approach to combatting the opioid crisis, potentially adding another layer to the complex legal landscape that has evolved around one of the most devastating public health crises in recent history.