Michigan AG Dana Nessel Takes Aim at OptumRx and ExpressScripts for Role in Opioid Crisis

Michigan Attorney General Dana Nessel files lawsuit against OptumRX and ExpressScripts, alleging profit-driven schemes worsened the opioid epidemic in the state.

LANSING – Michigan Attorney General Dana Nessel has initiated legal action against pharmacy benefit managers (PBMs) OptumRX and ExpressScripts, accusing the companies of fueling Michigan’s opioid crisis through improper dealings with manufacturers. Filed in the 3rd Circuit Court of Wayne County, the lawsuit contends these PBMs sought financial kickbacks by giving preferential treatment to opioids on their formularies, which helped drive excessive prescribing of these highly addictive drugs.

PBMs act as intermediaries between insurers and pharmaceutical companies, controlling which medications are covered and negotiating prices on behalf of insurance providers. Nessel’s lawsuit alleges that OptumRX and ExpressScripts used their market influence—controlling over 80% of Michigan’s pharmacy benefits market—to prioritize opioids, exacerbating the opioid crisis statewide. She claims the companies violated the state’s Drug Dealer Liability Act by promoting these substances while neglecting public health concerns.

PBM Practices Under Legal and Public Scrutiny

The opioid epidemic has devastated Michigan communities, with nearly 3,000 overdose deaths reported in 2022 alone, according to state health data. PBMs have long operated with little regulation, but state authorities and lawmakers are increasingly scrutinizing their role in drug pricing and access. In 2023, Nessel reached a settlement with CVS Caremark, another major PBM, as part of broader efforts to hold pharmaceutical industry actors accountable for opioid-related misconduct.

Nessel’s lawsuit comes amidst a growing push by states for stricter regulation of PBMs, especially regarding transparency and pricing practices. In recent months, Nessel and other attorneys general have urged federal action and appealed to the U.S. Supreme Court to affirm states’ authority to regulate PBMs. Critics argue that the industry’s rebate practices and formulary control have contributed not only to rising drug prices but also to the proliferation of opioids nationwide.

A Pattern of Settlements and Reforms

Since assuming office in 2019, Nessel has secured more than $1.6 billion in settlements with pharmaceutical manufacturers, distributors, and retailers for their roles in the opioid epidemic. These funds are earmarked for opioid treatment and prevention programs across Michigan. In March, the state launched a new website to track opioid settlement distributions, offering residents and local governments detailed insights into how these funds are being allocated.

By targeting PBMs like OptumRX and ExpressScripts, Nessel aims to tackle the crisis from another angle—holding intermediaries accountable for prioritizing profits over public safety. With similar lawsuits filed by other states, such as Mississippi and Kentucky, the legal campaign against PBMs marks a shift toward broader regulatory oversight of the pharmaceutical supply chain.

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