Opioid Lawsuit Places Blame on Pharmacy Benefit Managers


Pharmacy benefit managers may be held responsible for easing access to opioids.

The severity of the opioid epidemic has resulted in numerous lawsuits, mainly brought against pharmaceutical manufacturers and wholesalers.

For the first time, a lawsuit has been filed against pharmacy benefit managers (PBMs) for their role in allowing access to prescription opioids, STAT reported.

PBMs may have been omitted from litigation thus far due to the fact that a majority of Americans are unaware of the role PBMs play in the pharmaceutical supply chain, according to the article.

A suit filed in Webb County, TX, in January was recently absorbed into a hefty lawsuit in Ohio that picks up claims from across the country, STAT reported.

The Webb County lawsuit alleges that PBMs drove the opioid epidemic on the basis of increasing profits from the drugs.

“We see them as an absolutely essential part of this scheme,” Webb County lawyer Joanne Cicala told STAT. “They made sure these drugs were dispensed and they controlled their flow out into the communities.”

The lawsuit not only targets the 3 largest PBMs—CVS, Express Scripts, and OptumRx—but also include claims against smaller PBMs that operate in Texas—Navitus Health Solutions and Prime Therapeutics, according to the article. The suit alleges that manufacturers and wholesalers participated in fraud, conspiracy, and racketeering, which fueled the opioid epidemic.

However, legal experts told STAT that it may be difficult to prove the role of PBMs in overdose-related deaths and other consequences of the epidemic.

“They are far more removed than manufacturers and distributors,” Jodi Avergun, former chief of staff of the Drug Enforcement Administration and now a defense lawyer with Cadwalader, Wickersham and Taft, told STAT. “PBMs play a less significant role and one that’s harder to ascribe liability to under traditional tort principles.”

On the other hand, PBMs have access to opioid dispensing records for communities hit hard by the epidemic, which may reinforce their liability, according to the article.

Related Coverage: How Can Managed Care Pharmacists Help Combat the Opioid Epidemic?

“It’s hard for these companies to [argue] that in certain locales the volume of pills was for a legitimate medical purpose,” Rebecca Haffajee, professor of health management and policy, University of Michigan School of Public Health, told STAT. “The paper trail of prescriptions makes it more compelling, and those records should be disclosable.”

In the suit, PBMs are accused of giving opioids better positions on their formularies and making the drugs easier to access than less addictive alternative therapies, according to the article.

Spokespersons for nearly all of the accused PBMs denied all allegations brought against them and told STAT they plan to defend themselves against the claims. Several PBMs also gave examples of initiatives they have started to mitigate opioid abuse.

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