State of Mississippi v. Optum, Inc.

CourtDistrict Court, S.D. Mississippi
DecidedJune 9, 2025
Docket3:24-cv-00718
StatusUnknown

This text of State of Mississippi v. Optum, Inc. (State of Mississippi v. Optum, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. Mississippi primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State of Mississippi v. Optum, Inc., (S.D. Miss. 2025).

Opinion

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF MISSISSIPPI NORTHERN DIVISION

STATE OF MISSISSIPPI PLAINTIFF

V. CIVIL ACTION NO. 3:24-CV-718-KHJ-MTP

OPTUM, INC., et al. DEFENDANTS

ORDER

Before the Court is Plaintiff the State of Mississippi’s [12] Motion to Remand. For the reasons stated below, the Court denies the motion. I. Background This case arises from a state-court suit filed by Mississippi against various pharmacy benefit managers (PBMs) for their alleged roles in creating and sustaining an opioid epidemic in the state. Compl. [1-4] ¶ 17. Mississippi served Defendants Express Scripts, Inc., Express Scripts Pharmacy, Inc., ESI Mail Pharmacy Service, Inc. (collectively, “Express Scripts”), and OptumRx, Inc., on or after October 9, 2024. Joint Notice Removal [1] at 4. On November 8, Express Scripts and OptumRx (collectively, “the PBM defendants”) removed the suit to this Court, invoking the federal officer removal statute, 28 U.S.C. § 1442(a)(1). at 1–2. Before discussing Mississippi’s allegations, the Court provides some context on PBMs. Health insurance plans hire PBMs to serve as intermediaries between the plans and the pharmacies that beneficiaries use. , 592 U.S. 80, 83–84 (2020). So when “a beneficiary of a prescription-drug plan goes to a pharmacy to fill a prescription, the pharmacy checks with a PBM to determine that person’s coverage and copayment information.” at 84. And after

“the beneficiary leaves with his or her prescription, the PBM reimburses the pharmacy for the prescription, less the amount of the beneficiary’s copayment.” The plan then reimburses the PBM. PBMs offer other services as well. [1] at 4–5. They negotiate with pharmaceutical manufacturers for rebates on prescription drugs, and they develop formularies and utilization management tools for their clients. at 5;

[1-4] ¶ 24. “Formularies are lists of drugs covered by a pharmacy benefit plan,” and they “are often constructed in tiers, where drugs listed on higher tiers require larger copays . . . .” [1-4] ¶ 24. Since lower-tier drugs cost less than higher-tier drugs, consumers “are more likely to utilize drugs that have been placed on lower cost tiers . . . .” ¶ 110. On the other hand, utilization management tools regulate some drugs by limiting coverage unless doctors follow certain safeguards in prescribing them. ¶ 24.

Mississippi alleges that the PBM defendants played a key role “in facilitating the oversupply of opioids” by “colluding with Purdue Pharma and other opioid manufacturers to increase opioid sales . . . .” ¶¶ 17, 20; ¶ 125. According to Mississippi, the PBM defendants colluded, in part, by “negotiat[ing] rebate payments, fees, and other incentives from drug manufacturers in exchange for preferential placement of their drugs on PBM formularies.” ¶ 117; ¶ 20. Thus, Mississippi has sued the PBM defendants for public nuisance, negligence, violations of Mississippi consumer protection law, and unjust enrichment. ¶¶ 166–258.

The PBM defendants offer their services to both federal and nonfederal health plans that cover Mississippi residents. Mem. Supp. Resp. [21] at 19, 21. Express Scripts contracts with the U.S. Department of Defense (DOD) to administer the military’s TRICARE Home Delivery/Mail Order Pharmacy. [1] at 8. Likewise, Express Scripts, Inc. contracts with the U.S. Office of Personnel Management (OPM) to provide PBM services for health plans under the Federal Employees

Health Benefits Act of 1959 (FEHBA). at 11. And lastly, OptumRx contracts with the U.S. Department of Veterans Affairs (VA) to provide PBM services for the Veterans Health Administration’s (VHA) health plans. at 13–14. These federal contracts impose requirements on the PBM defendants. For example, Express Scripts’ TRICARE work is governed by a comprehensive, 174- page Statement of Work. at 8; DOD Statement of Work [1-2]. The DOD and VHA both require the PBM defendants to use premade formularies while each

FEHBA plan also controls what medications go on its formulary. [1] at 8, 12, 14. And since the FEHBA plans expect the PBM defendants to negotiate for rebates on the medications they place on their formularies, OPM specifically regulates certain aspects of those negotiations. at 12; FEHB Standard Cont. [1-3] at 26– 27. In their [1] Joint Notice of Removal, the PBM defendants contend that Mississippi seeks to hold them liable for acts they performed at the direction of federal officers. [1] at 2. They argue that since Mississippi challenges their conduct

in negotiating rebates and developing formularies for their clients, this case relates to their federal work. [21] at 21. Mississippi disagrees, arguing that it expressly and thoroughly waived all claims for relief relating to the PBM defendants’ work for the federal government. Mem. Supp. Mot. [13] at 10–13; [1-4] ¶¶ 33–34, 102–04. Even so, the PBM defendants assert that they performed negotiations for both their federal and nonfederal clients at the same time and developed

generalized formularies to offer to all their clients. [21] at 21. Therefore, the PBM defendants claim that Mississippi cannot challenge their nonfederal work without also implicating their federal work. II. Standard Normally, a defendant may remove a state-court action to federal district court only if the district court has original jurisdiction over the action. 28 U.S.C. § 1441(a). Original jurisdiction exists if “the plaintiff could have filed its operative

complaint in federal court, either because it raises claims arising under federal law or because it falls within the court’s diversity jurisdiction.” , 587 U.S. 435, 441 (2019); 28 U.S.C. §§ 1331–1332. “If at any time before final judgment it appears that the district court lacks subject matter jurisdiction,” the court must remand the case to state court. 28 U.S.C. § 1447(c). The removing party “bears the burden of showing that federal jurisdiction exists and that removal was proper.” , 771 F.3d 883, 887 (5th Cir. 2014) (cleaned up). And courts strictly construe the removal statute, resolving any doubts about the propriety of removal in favor of remand—especially when a

state brings a case in its own courts. , 134 F.4th 339, 347 (5th Cir. 2025); , 737 F.3d 78, 85 (5th Cir. 2013) (per curiam). But “[s]uits against federal officers are exceptional . . . .” , 527 U.S. 423, 431 (1999). “[A]ny officer (or any person acting under that officer) of the United States” may remove an action “for or relating to any act under

color of such office . . . .” § 1442(a)(1). Even “where the parties are not diverse and no federal question is raised in the complaint, [Section] 1442 allows a case to be removed if the federal actor asserts a federal defense.” , 101 F.4th 410, 414 (5th Cir.

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State of Mississippi v. Optum, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-of-mississippi-v-optum-inc-mssd-2025.