West Virginia Sues Express Scripts Over Role in Opioid Epidemic

West Virginia has joined several other states in suing the pharmacy benefit manager (PBM) Express Scripts for its alleged role in the opioid crisis. State Attorney General J.B. McCuskey announced the lawsuit, which follows similar actions from other states including Kentucky, Utah, and Michigan.

The Lawsuit

The complaint, at a whopping 128 pages, seeks to hold Express Scripts “accountable for leveraging its market dominance to exacerbate the opioid epidemic, the worst man-made crisis in modern medical history.”

The complaint accuses the PBM of prioritizing profits over compliance and public safety, thereby violating West Virginia law and contributing to an oversupply of opioids.

“The opioid crisis did not emerge in a vacuum – it was ignited and perpetuated by actors across the entire pharmaceutical supply chain,” notes the complaint. “Manufacturers, distributors, pharmacies, and PBMs, including Express Scripts, each played a pivotal role. While opioid manufacturers have drawn much of the public scrutiny, Express Scripts and other PBMs have worked to keep their own roles in the crisis obscured. That veil of secrecy is finally being lifted.”

The lawsuit alleges that Express Scripts violated West Virginia law in numerous ways, including conspiring with opioid manufacturers to deceptively market opioids; seeking preferred formulary placement for opioids in exchange for rebates; dispensing opioids through mail-order pharmacies without adequate controls or oversight; and ignoring overwhelming data regarding widespread opioid use disorder, overprescribing, and diversion. It claims the PBM was “not a passive actor. It was an architect of the crisis.”

The state is requesting a jury trial, and seeks damages of all sorts, including actual damages, punitive damages, treble damages, and exemplary damages.

The Takeaway

It is very likely that we will be seeing more of these cases in the future as states continue to grapple with the fallout caused by the opioid crisis.

Reference

State of West Virginia ex rel, John B. McCuskey, Attorney General v Evernorth Health Inc (formerly Express Scripts Holding Company); Evernorth Care Solutions Inc; Evernorth Direct Health, LLC, et al. No 5:25-CV-182. United States District Court Northern District of West Virginia; 2025. https://westvirginiawatch.com/wp-content/uploads/2025/08/express-scripts-lawsuit.pdf