Home Business Legal Pharmacy Benefit Managers Can’t Hide Business During New National Lawsuit

Pharmacy Benefit Managers Can’t Hide Business During New National Lawsuit


The opioid crisis is long past soaring to epidemic heights, and lawmakers are struggling with how to address a problem which affects all of us. At least two million Americans abuse prescription opioid pills. By comparison, only just over half a million are addicted to plain old heroin. Opioid pills and heroin lead to a combined 30,000 overdose deaths a year. That’s why a Texas community has decided to fight pharmacy benefit managers (PBMs) in court.

The goal is to publicize the inner workings of big pharma. PBMs control the rules that help make these drugs available to the public or not, and they also decide how much most of us pay out of pocket when we need a prescription for them. PBMs also stand to profit from the sale of these drugs, making it worth their while to flood the streets.

The Webb County Texas lawsuit was integrated with another much larger lawsuit already in the works in Ohio. If successful, that lawsuit will affect the way we implement treatment plans, police opioid addicts, and combine smaller lawsuits.

Opioid is a catchall phrase for controlled substances that covers street heroin and codeine, and also prescription pills that most of us have taken at one time or other: pills like hydrocodone, oxycodone, morphine, and fentanyl. These drugs work by stimulating the opioid receptors present in your brain and throughout your central nervous system. The stimulation accomplishes two goals. One, it dulls your perception of the pain you endure. For some, it also leads to intense euphoria. When used improperly, opioids can result in addiction.

Shockingly, only three PBM companies control the lion’s share of the U.S. market for opioids. The lawsuit alleges racketeering, fraud, and conspiracy charges against Express Scripts, OptumRx, and CVS Health.

It will be a difficult case to prove.

Most PBMs operate behind closed doors, and unless you work directly with them, it’s not easy to discover exactly how they function. If we can’t figure out how they operate, then we can’t hold them liable for the deaths that occur because of the rules they implement. Conversely, it’s nearly impossible for the aforementioned companies to argue that the number of drugs in public hands was for legitimate medical concerns. The volume is simply too astronomically high.

The case could be bolstered by the fact that there are records correlating the number of opioids dispensed with the increased number of deaths. Naturally, PBMs have asserted they’re only following the state and federal regulations that require compliance, and that no wrongdoing has occurred.

Melissa Thompson writes about a wide range of topics, revealing interesting things we didn’t know before. She is a freelance USA Today producer, and a Technorati contributor.

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