Arizona Is Suing the Opioid Middlemen. Its Own Prisons Spent $50.9 Million of the Last Settlement on Something Else.

On October 1, Arizona Attorney General Kris Mayes filed a consumer-fraud suit against Express Scripts and Optum, two of the country’s largest pharmacy benefit managers, alleging they pushed opioid prescribing for more than two decades: secret rebate deals that gave OxyContin preferred status, skipped safeguards such as prior authorization, and mail-order operations that kept filling prescriptions the companies’ own data flagged as suspect. The state wants profits disgorged, civil penalties, and restitution. Mayes: “Arizona families deserve accountability for conduct that contributed to addiction, overdose, and death.”

A lawsuit is a promise of money. What happens to the money is the story.

In May, the state auditor general found the Arizona Department of Corrections, Rehabilitation and Reentry may have spent $50.9 million of opioid settlement money treating hepatitis C in prisons, without documenting that the patients had contracted it through injecting opioids, as the agreement requires. The department disputes this and says at least 95% of the patients it treated got hepatitis C that way. An Attorney General’s spokesperson said the audit shows her concerns were valid: “This money should have been spent in communities that needed help all along.” He also noted that Arizona is one of a few states where opioid overdose deaths are rising while they fall nationally.

Money is still coming. Under the Purdue-Sackler deal, Arizona’s estimated share is $108,179,642, paid mostly in the first three years, bringing the state’s cumulative opioid proceeds to roughly $1.194 billion by Mayes’s count. She has asked the Legislature to appropriate the funds “directly to communities in need of support as soon as possible.”

Whether to treat hepatitis C in a prison is a real medical question. It is a different question from whether that money was meant for someone in Arizona trying to get a treatment bed. If you are looking for care in Arizona right now: naloxone is still sold over the counter at most pharmacies, and that is still yours regardless of where the settlement money lands.

For treatment providers and recovery organizations, the move this week is to read your county’s settlement-fund application rules and get your funding case on paper before the next appropriation. The state has a billion dollars and a documented problem spending it where it was meant to go. The people at the front of that line should be the people already doing the work.