County Counsel’s lawsuit describes the actions and omissions by Express Scripts and OptumRx (defendants) that the County alleges contributed to the opioid epidemic. The complaint alleges that defendants collaborated with opioid manufacturers, partnering with them in the deceptive, dangerous marketing of these all too often lethal drugs and, in exchange for rebates and other payments from opioid manufacturers, placed opioids on formularies with preferred status and with little to no limits on their approval for use. In addition, the County alleges instead of reporting illegitimate prescribing and sales uniquely visible to them in the extensive data they collect, the defendants ignored evidence of misuse, addiction, and diversion and used their data to boost their profits and manufacturers’ sales at the expense of public health and safety.
Defendants in the case are Pharmacy Benefits Managers (PBMs), which are alleged to be administrators hired by third party payers (insurers, employers) to design and administer prescription drug programs. As part of the prescription drug control system, it is alleged that PBMs are required to comply with the Controlled Substances Act, which creates an obligation to prevent “diversion” (i.e., improper distribution or prescription of controlled substances) and maintain effective controls against diversion and report suspicious orders. The complaint further alleges that PBMs operate mail order pharmacies and collect real time data on the opioids they dispense through both their mail order pharmacies and the pharmacies in their pharmacy network. The complaint alleges that defendants placed opioids on their formularies with preferred status and declined to impose limits on their approval for use in exchange for significant rebate payments from the opioid manufacturers. The complaint further alleges that defendants developed a business model that increased the utilization of opioids and maximized their profits.