State of Nevada v. Optum, Inc.

CourtDistrict Court, D. Nevada
DecidedMarch 30, 2025
Docket2:24-cv-00493
StatusUnknown

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

Bluebook
State of Nevada v. Optum, Inc., (D. Nev. 2025).

Opinion

1 2 UNITED STATES DISTRICT COURT 3 DISTRICT OF NEVADA 4 * * *

5 State of Nevada, Case No. 2:24-cv-00493-RFB-DJA

6 Plaintiff, ORDER

7 v.

8 Optum, Inc et al.,

9 Defendants.

10 Before the Court is Plaintiff’s Motion to Remand to State Court. For the following reasons, 11 the Court Grants the motion. 12 I. PROCEDURAL HISTORY 13 On March 12, 2024, Removing Defendant’s OptumRx, Inc., Express Scripts., ESI Mail 14 Pharmacy Service, Inc., Express Scripts Pharmacy, Inc., and Medco Health Solutions, Inc. 15 removed this case from the Eighth Judicial District Court to the U.S. District Court for the District 16 of Nevada. ECF No.1. On March 15, 2024, Plaintiff filed a Motion to Remand to State Court. ECF 17 No. 8. The motion was fully briefed on April 5, 2024. On October 22, 2024, the Court held a 18 Motion Hearing on Plaintiff’s Motion to Remand. ECF No. 57. 19 The Court’s Order follows. 20 II. FACTUAL ALLEGATIONS 21 The following facts are alleged in the operative Complaint. 22 Plaintiff, the State of Nevada, initiated this action against Defendants to abate the public 23 nuisance caused in part by the role of pharmacy benefit managers, inter alia, in worsening the 24 opioid epidemic in Nevada. 25 i. UHG/Optum Defendants 26 Defendant United Health Group, Inc. (“UHG”) operates through two connected divisions: 27 Optum and UnitedHealthcare. Defendant Optum, Inc. (“Optum”) is a wholly owned subsidiary of 28 UHG. Optum manages other subsidiaries that administer UHG’s pharmacy benefits, including 1 OptumRx, Inc. (“OptumRx”), which operates as the pharmacy benefit manager (“PBM”) for UHG. 2 Defendants OptumInsight, Inc., OptumInsight Life Sciences, Inc., and the Lewin Group, Inc., are 3 referred to collectively as “OptumInsight.” OptumInsight analyzed data and other information 4 concerning opioid prescription claims data and health plans’ opioid utilization for use in its 5 research and consulting efforts. 6 Plaintiff alleges that UHG, OptumRx Holdings, LLC and Optum are directly involved in 7 the conduct and control of OptumInsight’s and OptumRx’s operations, management and business 8 decisions. Therefore, Plaintiff collectively refers to UHG, OptumRx, and OptumInsight as 9 “UHG/Optum.” UHG/Optum is named as a Defendant in its capacity as (1) PBM, (2) data, 10 analytics, consulting, and research provider, and (3) mail-order pharmacy. 11 ii. ESI Defendants 12 Defendant Evernorth Health, Inc. (“Evernorth”), formerly known as Express Scripts 13 Holding Company, is the immediate or indirect parent of pharmacy, PBM, research/analytics 14 subsidiaries that operate throughout Nevada. Defendant Express Scripts, Inc. (“Express Scripts”) 15 is the immediate or indirect parent of pharmacy and PBM subsidiaries that operate throughout 16 Nevada. Defendant Express Scripts Administrators, LLC provided the PBM services in Nevada 17 during the relevant period. Defendant Medco Health Solutions, Inc. (“Medco”) merged with 18 Express Scripts in 2012. Prior to the merger, Medco provided the at-issue PBM and mail-order 19 services in Nevada. Defendant ESI Mail Pharmacy Service, Inc. is a wholly owned subsidiary of 20 Defendant Evernorth and provided mail-order pharmacy services in Nevada. Defendant Express 21 Scripts Pharmacy, Inc. also provided mail-order pharmacy services in Nevada. Defendant Express 22 Scripts Specialty Distribution Services, Inc. is a wholly owned subsidiary of Evernorth and 23 provided or assisted in providing PBM services. 24 The State alleges that Evernorth and Express Scripts, Inc. control Express Scripts 25 Administrators, ESI Mail Pharmacy Service, Medco, Express Scripts Pharmacy, and Express 26 Scripts Specialty Distribution Services’ operations, management, and business decisions. 27 Therefore, these Defendants are collectively referred to as “ESI.” The ESI Defendants are also 28 sued in their capacity as (1) PBM, (2) data, analytics, and research provider, and (3) mail-order 1 pharmacy. 2 iii. Carelon Defendants 3 Defendant Elevance Health, Inc. (“Elevance”) is the Blue Cross and Blue Shield licensee 4 for Nevada and offers PBM services through Defendant CarelonRx, its wholly owned subsidiary. 5 Defendant Carelon Insights, Inc., analyzes data and other information concerning opioid 6 prescription claims data and health plans’ opioid utilization for use in its research and consulting 7 efforts. 8 The State alleges that Elevance controls CarelonRx and Carelon Insight, Inc.’s operations, 9 management, and business decisions. Therefore, these Defendants are referred to collectively as 10 “Carelon.” Carelon is named as a defendant in its capacities as a (1) PBM and (2) data, analytics, 11 and research provider. 12 B. Definitions 13 Pharmacy benefit managers (PBMs) are entities hired to administer and manage 14 prescription drug benefits on behalf of various health benefits programs, including both 15 commercial and government programs. PBMs administer prescription drug benefits for health 16 plans, purchase drugs from manufacturers on behalf of those plans, and negotiate payment terms 17 for pharmacies that dispense the drugs to patients. 18 PBMs create lists of drugs that are selected to be covered by health plans. These lists are 19 known as “formularies.” PBM formularies are divided into tiers which establish out-of-pocket 20 costs consumers are to pay for a chosen drug. The first tier of a PBM drug formulary will be less 21 expensive for the consumer compared to the higher tiers. 22 C. Allegations 23 PBMs, such as those named as Defendants in this action, influence drug utilization by (1) 24 placing preferred drugs on lower tiers of their formularies and (2) implementing, or failing to 25 implement, utilization management tools which allow PBMs to (a) limit the quantity of drugs 26 dispensed, (b) require prior authorization before dispensing specific drugs, and (c) implement “step 27 edits” which require patients to try safer medication before progressing to more dangerous drugs. 28 Defendants in this action incentivized their clients to adopt Defendants’ standard 1 formularies by implementing financial consequences for deviating from them. Plaintiff alleges that 2 by incentivizing the use of their standard formularies as well as their utilization management tools, 3 Defendants dictated the consumer cost and any restrictions placed on prescription opioids. As a 4 result, by way of formularies with opioids placed on lower tiers and few restrictions, Defendants 5 ensured opioid sales to their drug manufacturer partners. In this way, Plaintiff alleges, Defendants 6 worked to increase opioid utilization in order to maximize profit and therefore directly contributed 7 to the dispensing of more opioid pills to individuals than were needed for legitimate medical 8 purposes. Simultaneously, Defendants allegedly falsely represented to their clients, patients, and 9 the public that they design drug formularies and programs in a manner that is cost effective and 10 promotes the safe use and appropriate prescription of opioids. 11 Additionally, Plaintiff brings claims against Defendants for failing to prevent diversion of 12 prescription opioids into the illegal market by, inter alia, monitoring and reporting suspicious 13 activity.

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