Pharmacy Benefit Managers (PBMs) have long operated as intermediaries between insurers, pharmacies, and drug manufacturers. These entities play a key role in controlling drug costs and access. Today, their involvement in the U.S. opioid epidemic is drawing scrutiny.

Several lawsuits, including one recently filed by Michigan Attorney General Dana Nessel, allege that PBMs facilitated and profited from the crisis by failing to implement safeguards against the overdistribution of opioids. These lawsuits are important. They hold PBMs accountable for their part in one of the most devastating public health crises in American history.

Profit Over Public Safety: How PBMs Allegedly Enabled the Opioid Crisis

As The New York Times recently reported, PBMs stand accused of prioritizing profits over public safety. These entities essentially opened the floodgates—and kept them open—enabling the distribution of excessive quantities of opioids that addicted and destroyed entire communities. Disregarding red flags and patterns of abuse, PBMs allegedly created financial incentives that encouraged pharmacies and manufacturers to push opioids onto the market.

Adding fuel to the fire, the companies then failed to monitor and limit the volume of opioids dispensed. This was a fundamental responsibility they assumed as gatekeepers in the prescription drug supply chain.

One of the most concerning allegations is that PBMs manipulated formularies—the list of drugs they approve and reimburse—to favor highly addictive opioid medications. This practice not only increased sales but also perpetuated widespread addiction.

The lawsuits we see today assert that PBMs acted negligently, facilitating an environment in which opioids could flow unchecked into communities already vulnerable to substance abuse.

Michigan and Other States Take Legal Action Against PBMs

The State of Michigan has taken a bold step in addressing PBMs’ role in the opioid epidemic. In October 2024, Attorney General Dana Nessel filed a lawsuit against PBMs, including Express Scripts, OptumRx, and CVS Caremark.

According to the Michigan Attorney General’s Office, these companies are accused of failing to detect or prevent the overdispensing of opioids. Levin Papantonio (LP) Attorneys Peter Mougey and Jeff Gaddy are working with Attorney General Nessel on this case.

Mougey emphasized the importance of accountability, stating, “PBMs’ actions have had devastating consequences for families and communities across Michigan. This lawsuit seeks to ensure that those responsible are held accountable and that resources are secured to prevent future harm.”

Mougey is a member of the national prescription opiate addiction multidistrict litigation Plaintiffs Executive Committee (PEC) and Co-Lead of the MDL’s Distributor and Dispensing case.

Similar cases have been filed elsewhere. In Utah, Attorney General Sean Reyes sued UnitedHealth Group and Express Scripts for allegedly playing a significant role in quadrupling opioid sales. According to the Utah Attorney General’s Office, PBMs failed to implement measures that could have mitigated the impact of the crisis.

Meanwhile, in Los Angeles County, a judge recently allowed a lawsuit against PBMs to move forward. As reported by Courthouse News Service, the case alleges that PBMs’ practices contributed directly to the widespread availability of opioids in California.

“By holding PBMs accountable, states hope to send a clear message: public health must take precedence over corporate profits,” Gaddy underscored.

Levin Papantonio’s Role in Opioid Litigation

Levin Papantonio has marched at the forefront of opioid litigation, representing numerous government entities in lawsuits against pharmaceutical manufacturers, distributors, and pharmacies. Mougey is a member of the national prescription opiate addiction multidistrict litigation (MDL) Plaintiffs Executive Committee (PEC) and Co-Lead of the MDL’s Distributor and Dispensing case.

Throughout the MDL, Mougey and Gaddy played critical roles in recovering over $60 billion in settlements, funds that are being used to help communities recover and to implement measures aimed at preventing future addiction crises.

New Mexico, for example, secured more than $1 billion for opioid crisis recovery efforts, with $500 million coming from Walgreens. This marks one of the largest individual settlements ever reached with a single opioid defendant in the United States and stands as the largest Attorney General settlement in New Mexico’s history.

An additional $274 million came to New Mexico from Kroger, CVS, Albertsons, and Walmart. Mougey and Gaddy served as co-leads of the trial team, alongside Dan Alberstone and Mark Pifko of Baron & Budd PC, Anthony Majestro of Powell Majestro PLLC, and Luis Robles of Robles Rael Anaya.

In August of 2024, the American Association for Justice awarded Mougey and other member law firms of the national opiates litigation PEC with its prestigious Steven J. Sharp Public Service Award.

“For years, these companies ignored their duty to protect public health,” Mougey said. “Our work has been about ensuring that those responsible for this crisis pay for the harm they’ve caused and that the resources are available to rebuild and protect communities.”

The Path Forward

The lawsuits against PBMs, including the groundbreaking case in Michigan, highlight a growing recognition of their role in the opioid epidemic. These legal actions not only aim to secure financial restitution for affected communities but also to establish stricter oversight of PBM practices moving forward.

The opioid epidemic has left an indelible mark on the nation, claiming hundreds of thousands of lives and devastating countless families. As these lawsuits progress, they represent a critical opportunity to address the systemic failures that allowed the crisis to flourish and to chart a new course toward accountability and prevention.