CHARLESTON — West Virginia Attorney General J.B. McCuskey’s office has filed a federal lawsuit against Express Scripts claiming the pharmacy benefit manager was the “architect” of the state’s opioid crisis.
The lawsuit was filed August 15 in federal court against Evernorth Health, formerly Express Scripts. The complaint says the company played a major role in oversupplying opioids to West Virginia.
McCuskey
“The opioid crisis is a direct result of greed and evil,” McCuskey said. “Opioid manufacturers have been held accountable, now it’s time for others who illegally profited behind the scenes to pay the price.
“PBMs, like Express Scripts, not only fueled the crisis through their formulary placements of the pills, but they had every tool at their disposal to alert them to how addictive and destructive opioids are. Instead, for decades they ignored their own data, broke state and federal laws and put profits over people’s lives. They have tried to hide their role in creating this crisis, but now it’s all coming to light and we will not stop until they pay for what they did to West Virginians.”
The lawsuit claims the company conspired with opioid manufacturers to deceptively market opioids and manipulate public perception regarding their safety and addictive potential. It says Express Scripts had real-time access to comprehensive prescription data that identified red flags, including doctor shopping, dangerous drug combinations and abuse patterns, but for decades the company chose to continue putting profits over public safety.
The complaint alleges Express Scripts’ misconduct was complex, far-reaching and violated West Virginia and federal law in multiple ways, including:
Securing preferred formulary placement for opioids in exchange for substantial rebates and fees—thereby incentivizing increased sales and undermining clinical judgment;
Eliminating or weakening utilization management (“UM”) protocols, such as prior authorization and quantity limits, which are designed to prevent excessive or inappropriate prescribing;
Ignoring overwhelming internal and external data that signaled widespread abuse, over prescription, and patterns of diversion — choosing profit over public safety; and
Dispensing opioids through mail-order pharmacies without adequate controls or oversight, in clear violation of West Virginia and federal controlled substances laws.
Other states, including neighboring Kentucky, have sued Express Scripts on similar grounds. In those cases, the company has said it has worked to combat opioid overuse and abuse and would fight the allegations.
West Virginia asserts violations of the West Virginia Consumer Credit and Protection Act, federal RICO violations, negligence and additional equitable and common law claims.
A PBM is a third-party company that manages prescription drug benefits for health insurers, employers and government programs. They negotiate drug prices with pharmaceutical companies, create formularies (lists of covered drugs) and process pharmacy claims.
PBMs do not take physical custody of drugs or directly distribute them. Instead, they sit at the center of prescription drug dispensing – they contract with the drug manufacturers to determine which drugs are covered by insurers and at what reimbursement rates. They also contract with pharmacies to establish dispensing terms and reimbursement structures.
Finally, they are hired by their clients, third-party payors such as consumer health insurance plans, to administer pharmacy benefits for consumers, including processing claims and managing patients’ out-of-pocket costs.
ExpressScripts also maintained a mail-order pharmacy which would fill opioid prescriptions.
U.S. District Court for the Northern District of West Virginia case number 5:25-cv-182
