Arizona AG Sues Express Scripts and Optum, Alleging PBMs Helped Fuel the State’s Opioid Crisis

SUNDAY, OCTOBER 4, 2026 — Arizona is going after the middlemen. Attorney General Kris Mayes announced Thursday that her office has filed a consumer fraud lawsuit against Express Scripts and Optum — two of the largest pharmacy benefit managers in the country — alleging that, for more than two decades, their deceptive practices substantially contributed to the opioid epidemic in Arizona. The complaint says the companies used their market power and unique access to real-time prescription data to promote increased opioid prescribing while concealing both the risks and the money that shaped their coverage decisions.

“These pharmacy benefit managers repeatedly violated Arizona law and placed the health and safety of Arizonans at risk,” Mayes said in Thursday’s announcement. “By designing formularies and safety programs around profit instead of patient protection, Express Scripts and Optum helped fuel the opioid crisis in our state. Arizona families deserve accountability for conduct that contributed to addiction, overdose, and death.”

What a PBM actually does

Before the allegations make sense, a quick explainer. A pharmacy benefit manager is the middleman between you, your insurer or employer, and the drug company. PBMs decide which drugs make a health plan’s formulary — the list of covered medications — and which tier they sit on, which determines what you pay at the counter. They also negotiate rebates: payments from drug manufacturers in exchange for favorable placement on that list. The three largest PBMs together manage coverage for hundreds of millions of Americans, which is why their formulary decisions carry enormous weight.

That’s also why Arizona’s complaint treats their choices as consequential rather than clerical. The state alleges the PBMs assured clients and the public that their formularies and safety controls prioritized clinical appropriateness — and then, in practice, designed them to maximize rebate revenue and other financial benefits from opioid manufacturers. Misrepresenting that the formularies and safety controls were built around safety and efficacy, while hiding the rebate agreements and financial incentives that created conflicts of interest, is the alleged deception at the heart of the Arizona Consumer Fraud Act claims.

The Purdue connection, as the state alleges it

The complaint’s most striking allegations involve Purdue Pharma, the now-bankrupt maker of OxyContin. According to the Attorney General’s office, the PBMs collaborated with Purdue and other opioid manufacturers to secure unrestricted, preferred formulary status for OxyContin and other opioids — in exchange for confidential payments. In return, the state says, the companies allegedly agreed not to apply basic utilization-management tools such as prior authorization or step therapy that would have reduced opioid dispensing. The absence of those controls, the complaint argues, is what allowed prescribing to run as hot as it did.

The allegations go further. The PBMs allegedly partnered with manufacturers to distribute misleading educational materials that downplayed addiction risks, and sold detailed prescriber and claims data to manufacturers — enabling targeted marketing campaigns aimed at high-volume prescribers. In Mayes’s telling, the PBMs were simultaneously the industry’s best-informed observers and its most invested enablers: “We allege that these PBMs had access to granular data indicating potentially illegitimate prescriptions, doctor-shopping, and dangerous dosage patterns, but prioritized speed and profitability in their mail-order operations over basic steps to prevent the diversion of opioid medication,” she said.

What Arizona wants — and what’s not yet proven

The lawsuit seeks restitution, civil penalties, injunctive relief, disgorgement of profits, corrective programs, and a court order prohibiting the PBMs from continuing the challenged practices. The complaint alleges 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.

It bears repeating: none of this has been proven. These are the state’s allegations, and no judge has ruled on them. Optum has denied the theory of the case. When Arkansas brought a similar suit against the same two companies in June 2024, an Optum spokesperson said the company “did not cause the opioid crisis or make it worse” and would defend itself in the litigation — adding that Optum takes the epidemic seriously and runs an Opioid Risk Management Program for its clients. As of publication, Express Scripts has not issued a public response to Arizona’s suit; Becker’s Hospital Review reported it had reached out to both companies for comment and would update when it hears back.

A familiar playbook, and a widening front

Arizona’s suit closely mirrors Arkansas’s June 2024 case against the same two PBMs, which accused Express Scripts and Optum of enabling the opioid epidemic through their formulary practices — including placing opioids on lower formulary tiers and failing to apply measures like prior authorization. The suits add to a broader wave of state scrutiny of PBM business practices. Missouri filed suit in January against 19 PBMs and drugmakers alleging a price-inflation conspiracy around insulin. On a separate front, PBMs have gone to court against 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.

The friction isn’t limited to opioids. The three largest PBMs have 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. The industry that once operated in the background is now fighting on multiple fronts at once.

The next step in the case is the companies’ formal response in court. The Previously news desk will track it as the litigation develops.