On Monday, the Utah Attorney General’s Office sued UnitedHealth Group, Express Scripts and their subsidiaries, which represent some of the country’s largest pharmacy benefit managers.

According to the complaint, the companies acted as “intermediaries” between opioid manufacturers, pharmacies, insurance companies and patients.

A pharmacy benefit manager often maintains pharmacy networks, processes prescription drug claims and sets up rebate payments to pharmacies. In their capacity as pharmacy benefit managers, Utah alleges UnitedHealth Group, Express Scripts and their subsidiaries helped “quadruple” the number of opioids sold in the U.S., which led to a “tripling of the number of Utahns who died from prescription opioid overdose.”

In a statement issued earlier this week, Executive Director of the Utah Department of Commerce Margaret Busse said pharmacy benefit managers played a “covert role” in the opioid crisis, which for several years has killed more than 100,000 Americans annually. Although rates appear to be in decline after hitting an unprecedented high of roughly 111,000 deaths in 2022, data suggests more than 100 Americans still die each day from some kind of opioid.

“We support efforts to unveil these hidden collaborations with pharmaceutical manufacturers, as transparency is essential for accountability and building trust within our community,” Busse said.

The complaint accuses the companies of colluding with manufacturers to give opioids “preferred status” as a prescription drug, while failing to use “the wealth of data” available that showed the dangers of overprescribing opioids. The state also alleges companies failed to comply with state and federal laws by “dispensing opioids through their mail order pharmacies.”

“Their conduct caused prescriptions and sales of opioids to skyrocket,” the complaint reads. It adds the companies “failed to place limits on their approval for use, even as evidence of the epidemic mounted, including in Utah, flooding the State with opioids and facilitating and encouraging the flow and diversion of opioids into an illegal, secondary market, resulting in devastating consequences to Utah, its residents, and its communities.”

As a result of this illegal market, opioids were readily available to teens and young people, while rates of addiction, overdoses, and opioid-related deaths spiked, the Attorney General’s Office argues. There are economic consequences, too, according to the complaint — companies continue to suffer financial losses, with widespread opioid addiction resulting in a less productive and healthy workforce. And the state is still dealing with increased costs related to healthcare services, law enforcement, social services and education.

“Pharmacy Benefit Managers took advantage of already dangerous situations and knowingly multiplied the tragic outcomes,” said Utah Attorney General Sean Reyes, who is set to leave office in January after not running for reelection. He will be replaced by Attorney General-elect Derek Brown.

The lawsuit is the latest in a series of legal actions taken against opioid manufacturers, pharmacies, marketing firms and other companies that played a role in the ongoing opioid crisis. To date, Utah has seen $540 million in settlements, funds that are slated for recovery programs, public health initiatives and harm reduction (which includes flooding communities with the overdose-reversing drug naloxone).

The complaint asks the court to order the companies to pay an unknown sum of money, enough to cover the “expenses required to abate fully the nuisance they have caused.”

Opioid-related settlements vary. In February, the state won $4 million in a settlement with a company that marketed OxyContin. In November, it won $45 million in a settlement with Kroger.

Utah News Dispatch is part of States Newsroom, the nation’s largest state-focused nonprofit news organization.