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The Republican attorney general accused Optum of playing a central role in what he called the reckless promotion, dispensing and oversupply of opioids. OptumRx controls a pharmacy network consisting of about 67,000 retail pharmacy locations nationwide, the suit said.

Kentucky was ravaged by the addiction crisis, resulting in some of the nation’s highest overdose death rates.

“These groups pushed a profit-fueled agenda at the expense of Kentucky families, who are left with empty seats at the dinner table,” Coleman said in a release.

Optum did not immediately respond to emails seeking comment Tuesday. When it was sued in September, Express Scripts responded that it has long worked to combat opioid overuse and abuse and would “vigorously contest these baseless allegations in court.”

Coleman initially filed the legal action in a state court, but the two sides are wrangling over whether it should be in state or federal court, his office said. He wants the case heard in state court.

Coleman has accused the defendants of using deceptive marketing to boost sales of highly addictive drugs. They also dispensed opioids through mail-order pharmacies without effective controls in violation of Kentucky and federal law, he said.

He is seeking, among other things, civil penalties for each willful violation of the Kentucky Consumer Protection Act, plus any other relief deemed appropriate by the court.

“Defendants have hidden their conduct through non-transparent business practices and by requiring each entity with whom they conduct business, such as opioid manufacturers, to enter into confidentiality agreements or otherwise keep their agreements confidential,” the lawsuit says.

Pharmacy benefit managers, or PBMs, run prescription drug coverage for health insurers and employers that provide coverage. They help decide which drugs make a plan’s formulary, or list of covered medications. They also can determine where patients go to fill their prescriptions.

PBMs have drawn the ire of politicians, patients and others for years. PBMs say they play an important role in controlling drug costs and pass along most of the discounts they negotiate to their clients.

Government lawsuits against pharmacy benefit managers are the latest frontier – and maybe the last big one – in years of litigation over the opioid-related drug epidemic in the U.S.

Drugmakers, wholesalers and pharmacy chains have already faced stacks of lawsuits and settled many of them, with most of the money required to be used to fight the overdose and addiction crisis.

Overdose death rates began steadily climbing in the 1990s because of opioid painkillers, followed by waves of deaths led by other opioids like heroin and — more recently — illicit fentanyl. A decline in appears to have continued this year, giving experts hope the nation is seeing sustained improvement in the persistent epidemic.

fell nearly 10% in 2023, marking a second straight annual decline, but state leaders say fatalities remain tragically high and the fight against the drug epidemic is far from over. Nearly 2,000 Kentuckians died last year from drug overdoses.