City of Boston Sues Major PBMs Over Role in Opioid Crisis

The city of Boston has filed a lawsuit against several major pharmacy benefit managers (PBMs) that alleges the companies collaborated with opioid manufacturers and helped fuel the opioid crisis, Boston.com reported.¹

What’s the Issue?

The lawsuit, brought by the city, the Boston Public Health Commission, and the Boston Housing Authority, was filed in Suffolk County Superior Court and names some of the largest PBMs in the US, including Express Scripts and OptumRx.

• The lawsuit alleges that the companies collaborated with opioid manufacturers, such as Purdue Pharma, and participated in “deceptive” and “dangerous” marketing.
• The original filing states that PBMs have access to data on opioid use and purposefully ignored evidence showing misuse and addiction in order to increase sales and profits.
• The lawsuit also alleges the PBMs violated state and federal law by not implementing the right controls against diversion when shipping opioids via mail.

Why it Matters

Thousands of state and local governments have filed suits against opioid manufacturers and distributors, but the city of Boston’s is the first to target PBMs specifically.

• PBMs manage prescription drug benefits for health plans and oversee prescriptions for many patients. Express Scripts and OptumRx serve a combined 165 million people.¹
• According to the CDC, opioid overdose deaths have been increasing since 2013, due largely to synthetic opioids. Of the 107000 overdose deaths in 2021, 75% involved an opioid.²

Expert Commentary

• "This is kind of a novel theory," University of Southern California law professor Adam Zimmerman told WBUR.³ "Usually when we sue for drugs that harm us, we're either focusing on the manufacturer of the drugs or the people at the front line selling us the drugs. We're not usually focusing on the middleman."
• “Optum did not cause the opioid crisis or make it worse, and we will defend ourselves in this litigation,” Optum said in a statement.¹ “Optum takes the opioid epidemic seriously and has taken a comprehensive approach to fight this issue, including the Opioid Risk Management Program, available to all Optum Rx clients, to address opioid abuse and promote patient health.”
• "One thing this case reflects is that the opioid epidemic wasn't really created by any one person or entity," Zimmerman told WBUR.³ "It took like a full-fledged regulatory breakdown as well as a major breakdown in institutional controls across the spectrum, across the entire distribution chain."

In Depth Insights

The lawsuit alleges that the PBMs were central figures in the distribution of opioids and called the companies "gatekeepers to the opioid market."³

• “The Defendants’ central role in the opioid crisis was made possible by their unique combination of knowledge and power that provided them with an extraordinary ability to control the opioid supply throughout the United States,” the lawsuit said. “Defendants along with their affiliated companies have more control over and insight into the flow of opioids into communities across the country than any other entities in the pharmaceutical distribution and payment chain.”
• “PBMs have adopted business practices designed to increase the utilization of opioids and maximize their own profits,” the lawsuit said. “As a result, far greater quantities of prescription opioids entered the market than Defendants knew could be necessary for legitimate, safe, or appropriate medical uses.”

Extra Reading

For more on this issue, check out these articles.

• Express Scripts Fueled Opioid Epidemic, Boston Lawsuit Claims (Bloomberg Law)
• Boston lawsuit alleges pharmacy benefit managers helped fuel opioid epidemic (WBUR)

References

1. Spatz E. Lawsuit by City of Boston alleges pharmacy benefit managers helped fuel the opioid epidemic. News Release. Boston.com. January 18, 2024. Accessed January 23, 2024. https://www.boston.com/news/local-news/2024/01/18/lawsuit-by-city-of-boston-alleges-pharmacy-benefit-managers-helped-fuel-the-opioid-epidemic/

2. Understanding the Opioid Overdose Epidemic. News Release. CDC. August 8, 2023. Accessed January 23, 2024. https://www.cdc.gov/opioids/basics/epidemic.html

3. Becker D. Boston lawsuit alleges pharmacy benefit managers helped fuel opioid epidemic. News Release. WBUR. January 17, 2024. Accessed January 23, 2024. https://www.wbur.org/news/2024/01/17/boston-lawsuit-alleges-pharmacy-benefit-managers-helped-fuel-opioid-epidemic