Summit County, Ohio, recently filed a lawsuit accusing Cigna Corp.’s Express Scripts and UnitedHealth Group’s Optum Rx PBMs of enabling the opioid addiction epidemic. The lawsuit calls out the “public nuisance” caused by the PBMs “facilitating the use of opioids by favoring, and failing to restrict” the use of opioids in their formularies while “collaborating with opioid manufacturers to deceptively and dangerously promote and fail to disclose the risk of opioids.” The suit also accuses the PBMs of “failures to maintain effective controls to prevent diversion in their own dispensing of opioids and to monitor their own claims data to prevent suspicious or inappropriate prescriptions.” The lawsuit does not seek to form a class of other local governments, but it represents perhaps the first attempt by a local government to seek damages from PBMs for epidemic levels of opioid addiction. Federal lawsuits have resulted in opioid epidemic damages paid to state and local governments, but the defendants in those suits have been manufacturers, such as Purdue Pharma L.P., and pharmacies, such as Walgreens Boots Alliance Inc. and CVS Health Corp. In settlements, CVS agreed to pay $5 billion to states over 10 years, and Walgreens agreed to pay $5.7 billion to states over 15 years. Purdue (and the Sackler family, which controls the company) agreed to pay $6 billion to states as part of its settlement.