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L.A. County sues pharmacy benefit firms, alleging they helped fuel opioid crisis

Los Angeles County has become the latest local government to accuse pharmacy benefit managers — the little-known middlemen of the prescription drug industry — of stoking the opioid crisis by helping flood the nation with highly addictive pills.

In a lawsuit filed Wednesday in Los Angeles County Superior Court, the county alleged that Express Scripts Inc. and OptumRx Inc. colluded with drug manufacturers to promote dangerously addictive opioids as a safe and moderate pain treatment option.

The 59-page filing describes the havoc that the opioid crisis has wreaked inside the county’s emergency rooms, schools and child welfare system: Children are raised by relatives or put in foster care due to parents’ addictions. Overdose patients are increasingly common in the county’s emergency rooms. And at least six students overdosed at the start of the 2022-23 school year, according to the suit.

The lawsuit alleges that pharmacy benefit managers, or PBMs — which act as the middleman between drug manufacturers and insurance companies — bear some of the blame for this rise in addiction. Behind the scenes, the companies effectively determine what drugs get covered by insurance companies and how much a patient will pay for it. Many also run their own mail service pharmacies.

Instead of advocating for the lowest price, the county alleges, the companies used “deceptive, dangerous marketing” to push dangerous drugs they knew would earn them a lucrative profit.

“Defendants are not bystanders in the opioid crisis,” the lawsuit said. “They helped fuel the fire.”

Representatives for Express Scripts and OptumRx did not respond Friday to a request for comment. Spokespeople for Express Scripts have called similar suits baseless.

The suit also names a half-dozen 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.

As opioid deaths keep rising, governments at the local, state and federal levels have gone after big corporations that drove the opioid crisis, seeking to hold them accountable for the devastation playing out in their communities. In recent years, opioid manufacturers, distributors, pharmacies and pharmacy benefit managers have been hit with thousands of lawsuits.

Counties in OhioTexas and Virginia have all filed similar suits to L.A. County’s, alleging that a small handful of pharmacy benefit managers turned a blind eye to obvious signs of addiction and drug abuse.

The county argues that Express Scripts and OptumRx were in a unique position to track the rise of the epidemic. The companies had data on opioid use for 166 million people covered by the insurance companies they contracted with, the county alleges, meaning they had real-time information how opioids were being abused among roughly half the U.S. population.

The county accused the companies of watching the opioid epidemic unfold and doing nothing.

“Instead of reporting illegitimate prescribing and sales uniquely visible to them in the extensive data they collect, the defendants ignored evidence of misuse, addiction, and diversion and used their data to boost their profits and manufacturers’ sales at the expense of public health and safety,” the lawsuit said.