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Los Angeles County Files Lawsuit Against Pharmacy Benefit Managers Alleging Opioid Crisis Responsibility

Lawsuit Alleges Collusion with Manufacturers to Promote Addictive Painkillers

By Dolores Quintana

A little-known group of middlemen in the prescription drug industry, pharmacy benefit managers (PBMs), have been the target of lawsuits from local governments seeking to reckon with the opioid crisis that has taken so many lives. Now Los Angeles County has joined other city governments in suing local PBMs for what the City sees as the PBM’s responsibility for the damage that opioids have caused. 

On Wednesday, September 6, Los Angeles County filed a lawsuit alleging that Express Scripts Inc. and OptumRx Inc. collaborated with drug manufacturers to promote patient use of highly addictive and dangerous opioid drugs without thought to the consequences. 

The 59-page lawsuit vividly outlines the toll the opioid crisis has taken within the county, affecting emergency rooms, schools, and the child welfare system. The suit highlights the impact on families, with children being raised by relatives or placed in foster care due to their parents’ addictions. The county’s emergency rooms are increasingly encountering overdose patients, and at least six students suffered overdoses at the beginning of the 2022-23 school year, according to the lawsuit.

The lawsuit contends that pharmacy benefit managers, acting as intermediaries between drug manufacturers and insurance companies, share some responsibility for the rise in addiction. These companies operate behind the scenes, effectively deciding which drugs are covered by insurance and how much patients will pay for them. 

Rather than working to lower drug prices, the county alleges that these companies engaged in “deceptive, dangerous marketing” to promote dangerous drugs they knew would generate substantial profits. The lawsuit asserts, “Defendants are not bystanders in the opioid crisis; they helped fuel the fire.”

The lawsuit also lists six related companies: Express Scripts Administrators LLC, Medco Health Solutions, ESI Mail Pharmacy Service Inc., Express Scripts Pharmacy Inc., OptumInsight Inc., and OptumInsight Life Sciences Inc.

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