Aneri Pattani
UnitedHealth Group’s multibillion-dollar pharmacy profit supervisor, Optum Rx, is suing 5 Kentucky counties in an try and pressure them out of nationwide opioid litigation in opposition to the corporate.
Pharmacy profit managers, typically known as PBMs, act as middlemen that negotiate prescription drug costs between drug firms, insurance coverage, and pharmacies. Some attorneys and advocates say PBMs helped gas the overdose disaster by failing to restrict the flow of opioid prescriptions.
As governments start exploring potential lawsuits in opposition to PBMs — a step that might signify the following wave in opioid-related litigation — Optum Rx is making an attempt to close down these efforts, in some circumstances earlier than they even totally take form.
In June, Optum Rx sued Anderson, Boyd, Christian, Nicholas, and Oldham counties in Kentucky for allegedly making selections about taking part within the new wave of nationwide opioid lawsuits behind closed doorways, violating Kentucky’s open conferences legislation. Optum Rx is asking courts to successfully pressure these counties to make their selections once more, this time in open conferences, doubtlessly with the hope that some received’t hassle due to the executive burden. The consequence might be fewer claims in opposition to the corporate and probably much less cash for it to pay in a future settlement.
But authorized specialists name Optum’s case “hypertechnical” and “frivolous,” and habit restoration advocates say it may set a harmful precedent for firms to evade accountability for his or her function in fueling the overdose disaster.
Christine Minhee, an lawyer, a nationwide skilled on opioid litigation, and founding father of OpioidSettlementTracker.com, mentioned Optum’s go well with reminded her of an adage amongst attorneys: “If the facts are on your side, pound the facts. If the law is on your side, pound the law. If neither is on your side, pound the table.”
“Right now, what we’re seeing is it pounding the table,” Minhee mentioned of Optum Rx. The firm is “desperately” attempting “to find some kind of foothold” to get circumstances in opposition to it thrown out.
Minhee mentioned these fits match a sample of Optum Rx utilizing skinny arguments to attempt to delay or evade opioid litigation nationwide.
Last yr, Optum Rx, together with one other PBM, asked a judge to throw out an opioid lawsuit filed by Los Angeles County, claiming throughout a December listening to that the county hadn’t proven hurt. The choose appeared skeptical of the claims and finally rejected the businesses’ request.
In April, the identical firms tried to oust a federal choose overseeing nationwide opioid litigation, claiming he was biased. Their argument was primarily based partly on a Florida lawyer’s having mentioned the choose was “plaintiff-oriented.” Their try failed.
Now, Optum Rx is working to maintain 5 Kentucky counties out of that very same sweeping opioid litigation.
That nationwide authorized enterprise started greater than seven years in the past, as jurisdictions noticed overdose deaths climb. Many individuals who had turn out to be hooked on prescription painkillers had been reduce off by their medical doctors, and a few transitioned to utilizing deadlier heroin or fentanyl. Health care and public security prices skyrocketed. Thousands of cities, counties, and states started suing well being care firms for allegedly making a public nuisance by aggressively advertising and marketing prescription painkillers and negligently distributing them.
Those circumstances had been lassoed collectively into the giant multidistrict litigation, which has resulted in massive settlements. The first few waves of settlements concerned opioid producers, distributors, and retail pharmacies, with firms reminiscent of Johnson & Johnson, CVS, and Walgreens agreeing to pay state and native governments billions of {dollars}. The cash is supposed for use for habit remedy and prevention providers — although its rollout has been controversial.
To add a brand new spherical of firms as defendants, jurisdictions should undertake a multistep course of, mentioned Peter Mougey, a Florida-based lawyer who represents many native governments within the huge nationwide litigation. The 5 Kentucky counties in query had been within the early levels of that course of, solely having requested the choose to amend their grievance, he mentioned. They hadn’t added Optum Rx but.
If Optum Rx’s fits are profitable, these counties would have the choice of redoing the preliminary steps of the method in a public assembly, then persevering with so as to add Optum Rx as a defendant, Mougey defined. The firm might hope that some counties received’t undertake the additional administrative effort.
Optum Rx’s “goal is clearly just to wear down and tire out these small counties,” Mougey mentioned. “They’re trying to have a chilling effect on the litigation.”
It’s not clear why Optum Rx focused these 5 counties out of the various localities enterprise the method so as to add the corporate as a defendant. The Kentucky counties vary from having fewer than 8,000 residents (Nicholas) to more than 70,000 (Christian). One is amongst the richest in Kentucky (Oldham), whereas others are poorer. Boyd County, in Appalachia, is among the hardest hit, with a latest overdose fee twice the state average.
Optum Rx, in its filing against Boyd County, which was just like claims in opposition to the opposite counties, mentioned native authorities had taken official authorized motion by asking the choose to make a change in its case. The go well with mentioned such motion should be finished in a public assembly and that the county didn’t maintain one.
Optum spokesperson Isaac Sorensen advised KFF Health News that the corporate’s argument just isn’t about “a technicality.”
It is “an important legal requirement designed to ensure accountability and transparency before a county takes legal action,” mentioned the assertion Sorensen supplied. “We have found many counties ignored this requirement, alongside their duty to preserve relevant evidence, and Optum Rx will defend against these improper legal actions.”
The 5 Kentucky counties disagree with these assertions, based on courtroom data. As of late July, all 5 had filed motions to dismiss Optum Rx’s declare.
Boyd County, just like the others, argued in its motion to dismiss that asking a choose to amend its grievance was a routine, procedural step that didn’t require a public assembly. Optum Rx jumped the gun, the county argued, submitting a case earlier than any last motion had been taken.
“No amended complaint has been filed. No new defendant, OptumRx included, has been added. No new lawsuit has been initiated,” Boyd County’s response mentioned.
The county additionally identified that it held an open assembly in 2017 that kicked off its involvement within the nationwide litigation and licensed future amendments to that litigation.
Hearings on the counties’ motions to dismiss Optum Rx’s fits are set for late August and early September, based on courtroom data.
These circumstances are shaping as much as be a Goliath-versus-David authorized motion. Although Oldham County is the wealthiest of the Kentucky counties that Optum Rx sued, its most recent budget is lower than 0.1% of Optum Rx’s annual income, which the corporate reported as exceeding $133 billion in 2024.
Oldham County Attorney D. Berry Baxter advised KFF Health News he’d seen the impression of the opioid epidemic as a prosecutor engaged on a rising variety of drug-related circumstances over time. Now, as settlement cash is arriving from different firms, it has funded elevated habit remedy in native jails. More settlement cash from further firms may increase such providers, Baxter mentioned.
If Optum Rx succeeds in kicking Kentucky counties out of the nationwide litigation, it might set “a really horrific precedent” for different PBMs and well being care firms to do one thing related, mentioned Tara Hyde, CEO of the statewide nonprofit People Advocating Recovery.
Hyde mentioned she’s been in restoration for greater than a decade from an habit that started with prescription painkillers for a damaged leg. She desires to see PBMs and different firms held accountable and made to vary their processes to forestall future crises.
Despite a latest decrease in overdose deaths nationwide, Hyde mentioned individuals in her state, their households, and the financial system are nonetheless hurting.
“Recovery doesn’t just happen overnight,” she mentioned. “Without these dollars that have been a direct result of people being misled, mistreated, and taken advantage of, we will still be detrimentally impacted.”
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF—an unbiased supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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