Arizona Attorney General Kris Mayes filed a consumer fraud lawsuit Oct. 1 against pharmacy benefit managers Express Scripts and Optum, alleging the companies’ formulary and rebate practices substantially contributed to the opioid epidemic in the state over more than two decades.
The complaint alleges the PBMs used their market power and access to real-time prescription data to promote increased opioid prescribing while concealing the financial arrangements shaping their formulary and utilization-management decisions, prioritizing rebate revenue from opioid manufacturers over patient safety.
It specifically accuses the companies of collaborating with Purdue Pharma to secure unrestricted, preferred formulary status for OxyContin in exchange for confidential payments, agreeing in return not to apply prior authorization or step-therapy controls that could have curbed opioid dispensing. The complaint also alleges the PBMs distributed misleading educational materials that downplayed addiction risks, and sold prescriber and claims data to manufacturers for targeted marketing to high-volume prescribers.
The lawsuit, brought under the Arizona Consumer Fraud Act, seeks restitution, civil penalties, injunctive relief, disgorgement of profits and corrective programs.
Arizona’s suit closely mirrors a similar one Arkansas filed against the same two PBMs in June 2024, which also accused Optum and Express Scripts of enabling the opioid epidemic through their formulary practices. An Optum spokesperson said at the time the company “did not cause the opioid crisis or make it worse” and would defend itself in the litigation.
The suits add to a broader wave of state scrutiny of PBM business practices, including a Missouri suit against 19 PBMs and drugmakers in January alleging a price-inflation conspiracy on insulin. The three largest PBMs have also expanded formulary exclusions to more than 600 drugs each in 2026, a trend that has drawn its own patient-access complaints, including a lawsuit against CVS Caremark after it dropped Zepbound from its largest commercial formulary in favor of Wegovy. PBMs have also faced legal fights over state laws restricting their business models: CVS sued Tennessee in May and Cigna’s Express Scripts followed in June, both challenging a law barring PBMs from owning pharmacies in the state.
Becker’s has reached out to Optum and Express Scripts for comment and will update this story if a response is received.
