CHARLESTON W.Va. (WVDN) — West Virginia Attorney General JB McCuskey has filed a lawsuit against Express Scripts (now Evernorth Health) and related entities, alleging the pharmacy benefit manager (PBM) played a central role in the widespread oversupply of opioids to West Virginia, destroying countless lives and leaving our state decimated by a man-made medical crisis.
“The opioid crisis is a direct result of greed and evil. Opioid manufacturers have been held accountable, now it’s time for others who illegally profited behind the scenes to pay the price,” Attorney General McCuskey said. “PBMs, like Express Scripts, not only fueled the crisis through their formulary placements of the pills, but they had every tool at their disposal to alert them to how addictive and destructive opioids are. Instead, for decades they ignored their own data, broke state and federal laws and put profits over people’s lives. They have tried to hide their role in creating this crisis, but now it’s all coming to light and we will not stop until they pay for what they did to West Virginians.”
The lawsuit, filed in the United States District Court for the Northern District of West Virginia, names Express Scripts as a central architect of the opioid crisis. The company conspired with opioid manufacturers to deceptively market opioids and manipulate public perception regarding their safety and addictive potential. Express Scripts had real-time access to comprehensive prescription data that identified red flags, including doctor shopping, dangerous drug combinations, and abuse patterns, but for decades the company chose to continue putting profits over public safety.
The lawsuit alleges Express Scripts’ misconduct was complex, far-reaching, and violated West Virginia and federal law in multiple, distinct ways, including but not limited to:
- Securing preferred formulary placement for opioids in exchange for substantial rebates and fees—thereby incentivizing increased sales and undermining clinical judgment;
- Eliminating or weakening utilization management (“UM”) protocols, such as prior authorization and quantity limits, which are designed to prevent excessive or inappropriate prescribing;
- Ignoring overwhelming internal and external data that signaled widespread abuse, over prescription, and patterns of diversion—choosing profit over public safety; and
- Dispensing opioids through mail-order pharmacies without adequate controls or oversight, in clear violation of West Virginia and federal controlled substances laws.
As one of the nation’s largest pharmacy benefit managers, Express Scripts controlled drug access for more than 100 million Americans and maintained contracts with approximately 65,000 retail pharmacies—over 98% of all U.S. retail pharmacies.
The State asserts violations of the West Virginia Consumer Credit and Protection Act, federal RICO violations, negligence, and additional equitable and common law claims.
The lawsuit can be found here.
Watch a playback of Monday’s news conference here.
About PBMs and Express Scripts
A PBM (Pharmacy Benefit Manager) is a third-party company that manages prescription drug benefits for health insurers, employers, and government programs. They negotiate drug prices with pharmaceutical companies, create formularies (lists of covered drugs), and process pharmacy claims.
PBMs do not take physical custody of drugs or directly distribute them. Instead, they sit at the center of prescription drug dispensing—they contract with the drug manufacturers to determine which drugs are covered by insurers and at what reimbursement rates. They also contract with pharmacies to establish dispensing terms and reimbursement structures. Finally, they are hired by their clients, third-party payors such as consumer health insurance plans, to administer pharmacy benefits for consumers, including processing claims and managing patients’ out-of-pocket costs. As a result, Express Scripts profited at every angle of an opioid transaction — paid by the manufacturers, the pharmacies, and the payors — all while shaping access and demand through its formularies.
ExpressScripts also maintained a mail-order pharmacy which would fill opioid prescriptions
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