Attorney General J.B. McCuskey announced a lawsuit against Express Scripts, a pharmacy benefit manager, alleging its central role in the opioid crisis.
The lawsuit claims St. Louis-based Express Scripts, now Evernorth Health, prioritized profits over public safety by manipulating opioid access and ignoring data indicating widespread abuse, contributing to the oversupply of opioids in West Virginia.
McCuskey, a Republican, spoke about the lawsuit during an appearance on MetroNews Talkline and during a press conference from the state Capitol.
“The opioid crisis is a direct result of greed and evil. Opiod manufacturers have been held accountable; now it’s time for others who illegally profited behind the scenes to pay the price,” McCuskey said.
Other states, including Kentucky and Utah, have sued Express Scripts on similar grounds.
In cases like those, Express Scripts has responded that it has long worked to combat opioid overuse and abuse and would vigorously contest the allegations.
McCuskey said Express Scripts operated by managing prescription drug benefits, influencing drug coverage and pricing. The attorney general alleges Express Scripts profited from all angles of opioid transactions while maintaining control over drug access for millions.
“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,” McCuskey said.
“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 State of West Virginia asserts violations of both state and federal laws, including consumer protection acts and RICO violations.
The lawsuit, filed in U.S. District Court for the Northern District of West Virginia, names Express Scripts as a central architect of the opioid crisis.
“By prioritizing profits over compliance and public safety, Express Scripts violated its legal duties under West Virginia law, contributing directly to the oversupply of opioids and the deepening of opioid use disorder across the state,” the lawsuit states.
The lawsuit alleges Express Scripts’ misconduct was complex, far-reaching, and violated West Virginia and federal law in multiple, distinct ways, including but not limited to:
- 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.
McCuskey, speaking on Talkline, said the State of West Virginia hopes to send a message through monetary penalties.
“Ultimately, what we’re asking for is money. And you know, in this world, accountability is achieved through financial transactions, and the amount of damage that has been done to the people of West Virginia isn’t monetizable,” McCuskey said on statewide radio.
“You can’t look at a mother who lost their son, you can’t look at a son who lost his mother and say, ‘This is how much that child or that person’s life was worth.’ You can’t look at an entire state and say, ‘We have destroyed your workforce, and we’ve destroyed the hopefulness of so many incredible, hard working people,’ and put a dollar figure on that.”
He continued, “This is generational damage that not only cost the state outrageous amounts of money, but cost us so much more in ways that are very, very difficult to quantify.”