A first opioid lawsuit has been targeting pharmacy benefit managers (PBMs), according to a report published in Managed Healthcare Executive. Their inclusion was due to their role in allowing access to prescription opioids.
The opioid epidemic or opioid crisis is the rapid increase in the use of prescription and non-prescription opioid drugs in the United States and Canada beginning in the late 1990s and continuing throughout the first two decades of the 2000s.
Opioids are a diverse class of moderately strong painkillers, including oxycodone (commonly sold under the trade names OxyContin and Percocet), hydrocodone (Vicodin), and a very strong painkiller, fentanyl, which is synthesized to resemble other opiates such as opium-derived morphine and heroin.
The potency and availability of these substances, despite their high risk of addiction and overdose, have made them popular both as formal medical treatments and as recreational drugs.
According to the U.S. Drug Enforcement Administration, "overdose deaths, particularly from prescription drugs and heroin, have reached epidemic levels.Nearly half of all opioid overdose deaths in 2016 involved prescription opioids."
Noting that until now, PBMs have not been sued for the opioid crisis, in February, a south Texas county included the three largest PBMs in a nationwide lawsuit, which focused on the opioid epidemic.
"While it takes some creativity to do something new (like looking at PBMs) as a responsible party, my hunch is that other lawyers are likely to learn from this and will be interested in a potential additional source of settlement funds," Harry Nelson, from Nelson Hardiman, LLP, a health care law firm, said.
Their inclusion was due to their role in allowing access to prescription opioids. PBMs are not expected to question physician's therapeutic choice and do not have the same professional obligations as pharmacists do.
However, they do have a lot of power, acting as the middlemen between doctor, patient, and pharmacy. They also have the most to gain from the cost of a prescription.
PBMs are likely to be increasingly targeted in litigation. Health plans are contracting with PBMs for the benefit of patients, and as such, the PBMs have a responsibility to protect patients from harm.
Allegations are likely to be that PBMs allowed a greater amount of opioids to be permitted in communities that could be supported based on the legitimate medical needs of the community.