The 70-plus-page lawsuit is directed at Express Scripts for its dealings with drug manufacturers in fueling the US opioid crisis.
At the end of September, Attorney General Russell Coleman (R, Kentucky) filed a complaint on behalf of his state claiming that Cigna’s pharmacy benefit manager (PBM) subsidiary, Express Scripts, had a significant role in fueling the deadly opioid crisis of the past few decades, according to a Spectrum News 1 article.1 Between working with manufacturers and conducting misleading marketing tactics, Express Scripts has recently felt the brunt of PBM scrutiny as it has now been sued by the Federal Trade Commission (FTC) and multiple states’ attorneys general.
“The role of Express Scripts in causing the opioid epidemic has been largely concealed from public view,” read the Kentucky lawsuit, according to an AP News article.2 “But it has now become clear that, for no less than the last 2 decades, Express Scripts has had a key role in facilitating the oversupply of opioids through intentional conduct that disregarded needed safeguards in order to increase the prescribing, dispensing, and sales of prescription opioids.”
For long-time residents of Kentucky, especially those in counties part of the Appalachia region, opioids have disproportionately impacted their communities since the 1990s. Kentucky has served as one of the epicenters of the opioid crisis because of the pain relief industry’s choice to break ground in blue-collar areas of the country, where citizens often work jobs that make them prone to injuries.1,3
For residents of Kentucky and surrounding Appalachian counties, the opioid epidemic is a personal issue.
“In Appalachian counties, the abundant availability of prescription painkillers was even more pronounced than in non-Appalachian counties. In 2017, opioid prescription rates were 45 percent higher in Appalachian counties than in the remainder of the country, and rates have consistently remained at least that much higher since 2006,” according to a report on opioids in Appalachia published by the National Association of Counties and the Appalachian Regional Commission.3
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While the inception of the opioid epidemic in the US is often blamed on Purdue Pharma,4 PBMs have had a spotlight shined on them with scrutiny for their role in distributing prescription benefits to patients across the country. PBMs, like Cigna’s Express Scripts, serve as prescription drug middlemen to negotiate prices with insurance plans and drug manufacturers.1 With the immense power PBMs wield to steer patients towards certain drugs for increased profits within the supply chain, they have been the recent recipients of scrutiny regarding rising prescription drug prices.
“Express Scripts and the other [PBMs] amassed an unprecedented level of power, using it to push opioid pills and conceal unlawful activity. They must be held to account for profiting off Kentucky families’ pain,” said Attorney General Coleman in a statement regarding the lawsuit.1
The lawsuit is mainly based on grounds that Express Scripts should take responsibility for the unprecedented volume of opioid prescriptions in the state of Kentucky; prescriptions that Express Scripts and other PBMs had a major role in filling. The lawsuit claims that Express Scripts allowed a suspicious number of opioids into the state of Kentucky without raising any alarms.2
Furthermore, highlighting Express Scripts’ potential wrongdoings, the lawsuit claims the PBM has been in violation of the Kentucky Consumer Protection Act, which “protects Kentucky's citizens from unfair, false, misleading, or deceptive acts or practices in trade or commerce,” according to the Office of the Attorney General.5
Similar to accusations against Purdue Pharma for its “deceptive acts” promoting oxycontin,4 the lawsuit states that Express Scripts’ role in the epidemic has been “largely concealed from public view.”2 The lawsuit also mentions Express Scripts’ use of mail-order pharmacies to push opioids without following the proper state and federal regulations.
In the past 2 years, overdose deaths have declined in Kentucky, but it still experienced nearly 2000 opioid-related deaths in 2023 and state leaders claim the crisis is far from over.2
On the other side of the lawsuit, Express Scripts stated, “We have long worked to combat opioid overuse and abuse, and we will vigorously contest these baseless allegations in court.” The company also offered its Advanced Opioid Management program as a way for patients to better understand the drug.1
“Because of Express Scripts’ actions in using its unique position to increase the availability of opioids in the marketplace and inflate opioid sales, because of its collusion with manufacturers in the deceptive marketing of opioids, and because of Express Scripts’ unique position within the system of opioid dispensing, without Express Scripts’ actions, opioid use would not have become so widespread, and the enormous public health hazard of prescription opioid and heroin overuse, abuse, and addiction that now exists would have been averted,” concluded the lawsuit.6
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