Arizona Sues Express Scripts and Optum Over Opioid Crisis Role

Arizona Attorney General Kris Mayes filed a consumer fraud lawsuit Thursday against Express Scripts and Optum, alleging that the two pharmacy benefit managers used their market power and their access to real-time prescription data to push opioid prescribing upward in the state for more than two decades.

The complaint targets companies that sit between insurers, drugmakers and pharmacies — deciding which drugs are covered on a health plan's formulary and on what terms. Mayes's office says that for years they designed those decisions around rebate revenue rather than patient safety, and concealed the financial arrangements behind them.

"These pharmacy benefit managers repeatedly violated Arizona law and placed the health and safety of Arizonans at risk," Mayes said in a statement. "By designing formularies and safety programs around profit instead of patient protection, Express Scripts and Optum helped fuel the opioid crisis in our state."

What the state says the companies did

According to the complaint, the PBMs collaborated with opioid manufacturers — particularly Purdue Pharma — to secure unrestricted, preferred formulary status for OxyContin and other opioids. In exchange for confidential payments from those manufacturers, the state alleges, the companies agreed not to apply basic utilization-management tools such as prior authorization or step therapy that would have reduced how much opioid medication was dispensed.

The complaint also accuses the companies of distributing educational materials that downplayed the addiction risks of opioids, and of selling detailed prescriber and claims data to manufacturers. That data, the state says, enabled marketing campaigns aimed at the doctors writing the highest volumes of opioid prescriptions.

Mayes's office alleges the PBMs had access to granular claims information showing potentially illegitimate prescriptions, doctor-shopping and dangerous dosage patterns, but chose speed and profitability in their mail-order operations over steps to prevent diversion.

The legal claims

The lawsuit was brought under the Arizona Consumer Fraud Act. It alleges deceptive practices and material omissions, including misrepresenting that formularies and safety controls were built around clinical safety and efficacy rather than profit, refusing to implement safeguards the companies said they would use, and concealing rebate agreements that created conflicts of interest in formulary design.

The attorney general's office says the conduct significantly increased the availability of opioids in Arizona, contributing to addiction, overdose and death and imposing billions of dollars in health care, emergency-response and societal costs. The suit seeks restitution, civil penalties, injunctive relief, disgorgement of profits and corrective programs, along with a court order barring the companies from continuing the challenged practices.

Express Scripts and Optum have not responded publicly to the filing.

The backdrop in opioid litigation

The case lands during a broader wave of litigation over how the prescription opioid supply chain was managed. Purdue Pharma's $7.4 billion bankruptcy plan became legally effective May 1, 2026, dissolving the maker of OxyContin and barring members of the Sackler family from the U.S. opioid business.

Much of that litigation has moved from manufacturers to the intermediaries that controlled access. States and cities have increasingly argued that the same rebate-driven dynamics that made opioids cheap and easy to prescribe also kept safer, evidence-based alternatives harder to reach for patients who needed them.

The distinction matters for people who developed opioid use disorder after being prescribed the drugs. The Food and Drug Administration has approved three medications for the condition — buprenorphine, methadone and naltrexone — and medication-assisted treatment is the standard of care. Yet research has repeatedly found that most people who need those medications never receive them, a gap that has narrowed only slowly even as overdose deaths have declined nationally.

Arizona's case is the latest attempt to assign financial responsibility for that gap to the companies that shaped which prescriptions got filled in the first place.