The City of Boston v. Express Scripts, Inc.

CourtDistrict Court, D. Massachusetts
DecidedFebruary 11, 2025
Docket1:24-cv-10525
StatusUnknown

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

Bluebook
The City of Boston v. Express Scripts, Inc., (D. Mass. 2025).

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF MASSACHUSETTS ___________________________________ ) THE CITY OF BOSTON, THE BOSTON ) PUBLIC HEALTH COMMISSION, and ) THE BOSTON HOUSING AUTHORITY, ) ) Plaintiffs, ) Civil Action v. ) No. 24-cv-10525-PBS ) EXPRESS SCRIPTS, INC., et al., ) ) Defendants. ) ___________________________________)

MEMORANDUM AND ORDER February 11, 2025 Saris, D.J. INTRODUCTION This case involves the opioid epidemic, which has devastated communities nationwide, including the City of Boston. The epidemic has generated national litigation. In 2024, the City of Boston1 brought this action against Express Scripts2 and Optum3 for contributing to the opioid epidemic in their roles as pharmacy

1 Plaintiffs include the City of Boston, the Boston Public Health Commission, and the Boston Housing Authority (collectively, “the City”).

2 “Express Scripts” refers to Defendants Express Scripts, Inc., Express Scripts Administrators, LLC, Express Scripts Pharmacy, Inc., Medco Health Solutions, Inc., ESI Mail Pharmacy Services, Inc., and ESI Mail Order Processing, Inc.

3 “Optum” refers to Defendants UnitedHealth Group, Inc., OptumRx, Inc., OptumInsight, Inc., and OptumInsight Life Sciences, Inc. benefit managers (“PBMs”). Express Scripts and Optum, two of the largest PBMs in the United States, have formularies in Massachusetts and partner with major Boston insurers. The City alleges Express Scripts and Optum collaborated with opioid manufacturers to misrepresent the risks of opioids and used preferred formulary placement to ensure the drugs would be covered

by prescription health insurance, increasing demand and proliferation of opioids in the City. The City claims that, through these actions, Defendants created a public nuisance under Massachusetts law and violated the federal Racketeer Influenced and Corrupt Organizations Act (“RICO”). Defendants have moved to dismiss, arguing the claims are time- barred and the complaint fails to state a claim. In addition, Defendants UnitedHealth Group, Inc. and OptumInsight, Inc. seek dismissal for lack of personal jurisdiction. After a hearing, the Court ALLOWS Defendants’ motion to dismiss for failure to state a claim (Dkt. 47) on the ground that

the claims are time-barred and the City lacks standing to pursue equitable relief. Defendants UnitedHealth Group, Inc. and OptumInsight, Inc.’s motion to dismiss for lack of personal jurisdiction is DENIED as moot (Dkt. 45). BACKGROUND The City alleges the following facts in the amended complaint, which the Court accepts as true at this stage. See Artuso v. Vertex Pharms., Inc., 637 F.3d 1, 5 (1st Cir. 2011). I. The Opioid Epidemic A. National Crisis

In 2016 alone, pharmacies in the United States filled 289 million opioid prescriptions, “enough to medicate every adult in America around the clock for a month.” Dkt. 36 ¶ 3. The widespread availability of opioids since the 1990s has contributed to a decline in American life expectancy for the first time in recorded history. In October 2017, the President of the United States declared the opioid epidemic a public health emergency, a determination that federal officials have renewed multiple times since. Between 1996 and 2019, more than 500,000 people died from an opioid overdose. By 2021, the number of deaths involving prescription

opioids was nearly five times the number in 1999. The “worst man- made epidemic in modern medical history” has impacted most Americans either directly or indirectly. Id. ¶¶ 2-3. B. The City’s Public Health Crisis The opioid epidemic has devastated Massachusetts, with Boston hit particularly hard. In Boston, the opioid prescription rate between 2010 and 2016 was double the state average and three times the national average. Consequently, Boston has accounted for the largest share of opioid-related fatalities in Massachusetts. In 2021, the City recorded 251 opioid overdose deaths, and in 2022, there were 2,670 opioid-related incidents. In response, the City implemented costly interventions, including an engagement center for recovery services and the

installation of opioid reversal kits in public buildings. Despite these efforts, the crisis overwhelmed emergency responders and disrupted daily life. The Boston Fire Department’s administration of Narcan, the antidote to opioid overdose, nearly tripled from 2014 to 2017. Law enforcement faced increased arrests, violent crimes, and property theft linked to the crisis. Libraries and parks reported frequent drug overdoses and discarded drug paraphernalia. Residents in public housing encountered needles and unconscious individuals in shared spaces, prompting security upgrades and cleanup efforts. Families suffered, with reports of infants born addicted to opioids and parents who prioritized drug

purchases over basic needs. II. The Role of PBMs The City alleges that its harms are connected to the actions of PBMs, which play a critical role in the distribution and accessibility of prescription opioids. A. PBMs and the Pharmaceutical Industry PBMs partner with health-care sponsors, such as insurers, employers, government entities, and unions, to administer prescription drug benefits for health-plan members. They create and manage national formularies, which determine the terms under which prescription drugs are reimbursed. When it comes to opioids,

their formularies determine the quantities of opioids available, co-pay amounts, the level of authorization needed for dispensing, and whether alternatives, like less addictive drugs, will be available. Drug manufacturers vie for placement on PBMs’ formularies by offering rebates and other incentives. These rebates and incentives to PBMs, which have increased by 16% annually since 2014, now constitute at least 40% of branded prescription drug costs. B. Deceptive Opioid Marketing and Rebates According to the amended complaint, Express Scripts and Optum

colluded with opioid manufacturers to downplay addiction risks and overstate the benefits of opioids. Express Scripts’ “Pharma Portal” provided manufacturers with extensive consumer data, while both PBMs developed studies and presentations misrepresenting opioid safety. In exchange for substantial rebates, Express Scripts and Optum prioritized opioids on their formularies. For example, in 2000, Purdue Pharma (“Purdue”), an opioid manufacturer, paid $4.2 million in rebate payments to Express Scripts to support OxyContin’s, an opioid manufactured by Purdue, formulary placement. By 2011, Purdue’s annual rebate payments to Express Scripts exceeded $56.5 million. Lured by high rebates, Defendants undermined any efforts to

implement safeguards to detect and prevent misuse. In 2016, Express Scripts considered enhancing safeguards but decided against it after Purdue tied rebate agreements to low levels of review. Optum refused to heighten safety measures after similar pressures in 2017. III. Opioid Multi-District Litigation The opioid epidemic spurred nationwide litigation. In 2018, the City filed a suit against manufacturers, distributors, and pharmacies due to their roles in the opioid epidemic; Express Scripts and Optum were not defendants in that action. In 2018 and 2019, three cases were filed by other cities and counties against

Express Scripts and Optum for their role in the opioid crisis. See County of Webb v. Purdue Pharma, L.P., No. 18-op-45175 (N.D. Ohio Feb. 15, 2018); City of Independence v. Williams, No. 19-op-45371 (N.D. Ohio June 10, 2019); City of Rochester v. Purdue Pharma, L.P., No. 19-op-45853 (N.D. Ohio Oct. 17, 2019). Those cases, along with another filed in 2020, have been selected as bellwether cases filed against PBM defendants in the National Prescription Opiate Multi-District Litigation (“MDL”) in the Northern District of Ohio. See In re Nat’l Prescription Opiate Litig., No. 17-md-2804 (N.D. Ohio Oct. 27, 2023), Dkt. 5231.

DISCUSSION I.

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