Arizona is taking two of the nation's largest prescription drug middlemen to court over the opioid epidemic. On Oct. 1, Attorney General Kris Mayes filed a consumer fraud lawsuit alleging that Express Scripts and Optum spent more than 20 years shaping drug coverage in ways that pushed more opioids to Arizona patients while hiding the risks.
None of the allegations have been proven, and no court has ruled. MedicalDaily found no public response to the Arizona case from Express Scripts, its parent company Cigna, Optum, or its parent company UnitedHealth Group as of publication.
The case matters to families because pharmacy benefit managers, or PBMs, shape what happens at the pharmacy counter: which drugs a plan covers, what patients pay, and whether a doctor needs approval before a prescription is filled.
The State's Case Against Two Prescription Gatekeepers
According to the Arizona Attorney General's announcement, the complaint alleges the companies used their market power and access to prescription data to promote more opioid prescribing while concealing the risks and their financial arrangements with drugmakers. The state claims they told clients their coverage lists put patient safety first while designing them around profit.
A central allegation involves Purdue Pharma. Arizona claims the PBMs gave OxyContin preferred coverage status and, in exchange for confidential payments, avoided safety tools such as prior authorization or step therapy that can limit opioid prescriptions.
The state also alleges the companies distributed materials downplaying addiction risks, sold prescriber data to drugmakers so they could target high-volume prescribers, and ignored warning signs of misuse, as KOLD reported.
"By designing formularies and safety programs around profit instead of patient protection, Express Scripts and Optum helped fuel the opioid crisis in our state," Mayes said in a statement. She added that the companies "had access to granular data indicating potentially illegitimate prescriptions, doctor-shopping, and dangerous dosage patterns" but prioritized speed and profit in their mail-order operations.
The state is seeking restitution, civil penalties, the return of profits, corrective programs, and a court order halting the challenged practices.
Formularies, Rebates, and the Power to Say No
A formulary is the list of drugs a health plan covers. "Preferred" drugs usually cost patients less and face fewer hurdles. Prior authorization requires a doctor to justify a prescription before the plan pays, and step therapy requires a patient to try another option first.
These tools are at the heart of the case. The state's theory is that the PBMs could have slowed risky prescribing but chose not to because of payments from manufacturers. Whether that happened, and whether it caused harm in Arizona, is for a court to decide.
The companies have enormous reach. A Federal Trade Commission interim report released in July 2024 found that the top three PBMs, which include Express Scripts and Optum Rx, "processed nearly 80 percent of the approximately 6.6 billion prescriptions dispensed by U.S. pharmacies in 2023."
Arizona's Overdose Toll and the Shift to Fentanyl
The Arizona Department of Health Services 2023 surveillance report counted 1,928 opioid overdose deaths in 2023, a rate of 25.6 per 100,000 residents. The death rate roughly doubled from 2017 to 2021, then dipped about 8% by 2023.
A May 2025 state health department update reported 1,651 provisional opioid deaths in 2024, a 14.4% drop, or about four Arizonans a day. Those figures are preliminary, with data through December 2024. Mohave, Pima, Maricopa, and Graham counties had the highest death rates.
Adults ages 35 to 44 had the highest death rate in 2024, and men accounted for 71.3% of fatal overdoses. The 2023 report also found steep increases in death rates among Black and Native American Arizonans since 2017.
The epidemic has also changed. In 2023, 97.6% of Arizona opioid deaths involved prescription or synthetic opioids, a category that includes illicit fentanyl, and opioid prescriptions in the state fell about 20% from 2019 to 2023, according to the state report. State data cannot show how much any single company contributed to these deaths.
Arizona Joins a Growing List of States Targeting PBMs
Arkansas sued Optum and Express Scripts over opioids in June 2024, and Utah filed suit against UnitedHealth Group and Express Scripts in December 2024.
When Arkansas sued, an Optum spokesperson said, "Optum did not cause the opioid crisis or make it worse, and we will defend ourselves in this litigation," according to Healthcare Dive. Express Scripts did not respond to a request for comment at the time.
The lawsuit does not change anyone's current coverage. Patients taking prescribed opioids should not stop or change their medication without talking with a clinician, because abrupt changes can cause withdrawal. Anyone worried about opioid use can call Arizona's free, 24-hour Opioid Assistance and Referral Line at 1-888-688-4222.
Arizonans can also file consumer complaints with the Attorney General's Office. The next step in the case is the companies' formal response in court.
Key Questions Answered
Who is Arizona suing?
Attorney General Kris Mayes sued Express Scripts and Optum, two of the largest U.S. pharmacy benefit managers, on Oct. 1, 2026.
Has anything been proven?
No. The claims are the state's allegations, and no judge has ruled on them.
What is a pharmacy benefit manager?
A PBM manages prescription drug coverage for insurers and employers, shaping which drugs are covered and what patients pay.
What does the state want?
Restitution, civil penalties, the return of profits, corrective programs, and a court order halting the challenged practices.
Does this affect my current prescriptions?
No. The lawsuit does not change anyone's coverage. Do not stop or adjust prescribed medication without talking with a clinician.
Where can Arizonans get help with opioid use?
The state's free, 24-hour Opioid Assistance and Referral Line, 1-888-688-4222, offers help and referrals.
Published by Medicaldaily.com
