Michigan’s Attorney General goes after PBMs for their alleged role in the crisis, citing the state’s Drug Dealer Liability Act.
Michigan Attorney General Dana Nessel is taking action in the fight against the opioid crisis, and this time her focus is on the major pharmacy benefit managers (PBMs) operating in the state. Nessel has officially filed a lawsuit against OptumRX and ExpressScripts, accusing them of playing a significant role in fueling Michigan’s opioid epidemic. Her allegations go beyond standard accusations, suggesting that these PBMs not only mismanaged the distribution of prescription opioids but also deliberately colluded with opioid manufacturers, securing kickbacks in exchange for favorably placing these addictive drugs on formularies. This practice, Nessel contends, significantly contributed to the widespread availability and misuse of opioids across Michigan.
In her lawsuit, Nessel claims that OptumRX and ExpressScripts conspired with manufacturers by placing their products in favorable positions on formularies—lists of drugs that PBMs recommend and reimburse for. These PBMs have the power to negotiate rebates and deep discounts from drug manufacturers by deciding which drugs are included in insurance formularies. With control over most of Michigan’s pharmacy benefit market, OptumRX, ExpressScripts, and CVS Caremark are all major players in determining the accessibility of many drugs, opioids and other addictive ones included.
Nessel’s complaint against the PBMs is based on accusations of public nuisance, negligence, and violations of Michigan’s Drug Dealer Liability Act, which allows individuals who have been harmed by the illegal distribution of controlled substances to pursue civil lawsuits against drug dealers. Her claim of public nuisance addresses the widespread harm she believes was inflicted upon communities by these companies. Alleging negligence, Nessel argues that the PBMs failed in their duty to Michigan residents by not exercising caution and adequately overseeing opioid sales.
Over the years, PBMs have managed to operate with little oversight or regulation, in general, creating a situation in which state officials are left to bear the burden of protecting consumers from potential abuses. Federal regulation has been scarce, forcing states like Michigan to step in. Nessel has been a vocal advocate in this area, joining bipartisan groups of attorneys general calling for federal regulations. Earlier this year, she and her colleagues urged Congress to take action against PBMs, and later in the year, they petitioned the U.S. Supreme Court to clarify states’ authority in regulating these entities.
Since her election in 2019, Nessel has been actively tackling the opioid crisis, too, through legal means, securing over $1.6 billion in settlements from companies involved in the opioid supply chain. Major settlements with distributors, drug manufacturers, and large pharmacies have helped Michigan redirect funds towards substance abuse treatment and prevention programs. In March 2024, her office launched a new website to inform residents about opioid settlement distributions, making it easier for local governments to track available resources and direct them to areas most in need.
According to Michigan’s Department of Health and Human Services (MDHHS), in the two-decade span from 2000 to 2020, the state’s opioid death rate increased annually by nearly 14 percent. In 2022, nearly 3,000 Michiganders lost their lives to drug overdoses. For Nessel, taking on PBMs like OptumRX and ExpressScripts is one more step toward curbing the damage inflicted by these drugs and their availability. The outcome of this lawsuit could signal a major shift in the way PBMs operate in Michigan and potentially beyond.
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Michigan attorney general sues ‘pharmacy benefit managers’ over role in opioid crisis
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