By Dietrich Knauth
Dec 8, Reuters – West Virginia sued United HealthGroup on Monday in federal court, alleging that the company’s pharmacy benefit manager Optum fueled the state’s opioid crisis by oversupplying its communities with addictive painkillers.
State Attorney General J.B. McCuskey said West Virginia was already struggling with an addiction crisis when Optum began trying to evade legal safeguards that were meant to limit opioid sales.
“Optum saw a business opportunity,” McCuskey said in a statement. “And in its greed, Optum chose to make things worse.”
United HealthGroup did not immediately respond to a request for comment.
Pharmacy benefit managers handle prescription drug benefits for health insurance companies, large employers, and Medicare prescription drug plans — a group often referred to as payers.
The state’s lawsuit alleges that Optum conspired with other companies in the drug industry to increase the “flood of pills” being sold in Virginia, saying that the company worked to increase daily dosage limits for opioid prescriptions and penalized clients who tried to curb opioid abuse with dispensing restrictions.
PBMs can control which drugs are covered by insurance plans, giving them a “gatekeeping” role that should have allowed Optum to stem excessive opioid sales by refusing insurance coverage, according to the lawsuit. Instead, Optum took payments from drug companies to clear away obstacles to the sale of opioid drugs, ensuring that they were covered by insurance and recommended to doctors, according to the lawsuit.
“Rather than use its influence and data to reduce harm, Optum actively supported opioid manufacturers by helping plan marketing strategies, analyzing sales, and shaping formularies to maximize opioid utilization,” West Virginia wrote in the lawsuit.
Optum also directly dispensed opioids through mail-order pharmacies without adequate controls or oversight, according to the lawsuit.
Optum reached a $20 million settlement last year to resolve the federal government’s claims that it ignored “red flags” when selling opioids through a California mail order pharmacy it operated.
West Virginia’s complaint asserts violations of the West Virginia Consumer Credit and Protection Act, federal RICO (Racketeer Influenced and Corrupt Organizations Act) violations, negligence, and additional equitable and common law claims.
The state previously sued pharmacy benefit manager Express Scripts over similar allegations in August 2025. Express Scripts has denied the allegations and moved to dismiss West Virginia’s complaint.
Opioid addiction is an epidemic in the United States, and the health crisis has sparked thousands of lawsuits accusing drug companies of contributing to the problem by deceptively marketing opioid painkillers like Oxycontin as less-addictive alternatives for pain treatment. Drug manufacturers, pharmacy chains and drug distributors have agreed to pay more than $50 billion in opioid settlements with state and local governments.
Several lawsuits against PBMs over their role in the opioid epidemic have been centralized in a federal multidistrict litigation in Ohio.
The case is West Virginia v. UnitedHealth Group Inc, U.S. District Court for the Northern District of Virginia, No. 25-cv-00267
For West Virginia: Jace Goins, Abby Cunningham of the Office of the West Virginia Attorney General
For UnitedHealth: Not yet known
Read more:
US appeals court revives $2.5 billion opioid lawsuit in West Virginia
UnitedHealth’s Optum to pay $20 mln over US claims it ignored opioid ‘red flags’
Optum, Express Scripts seek to oust judge in opioid cases
(Reporting by Dietrich Knauth in New York, Additional reporting by Mike Scarcella in Washington, D.C.)
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