Jefferson County’s long-running opioid fight with pharmacy benefit managers Express Scripts and Optum Rx now has a firm trial date, and the judge is clearing a big chunk of the calendar for it. A jury trial is scheduled for March 2027, with the court reserving the entire month starting March 1. The county says the PBMs’ formulary and pricing decisions helped keep prescription opioids flowing into the community and stuck local taxpayers with policing, incarceration and treatment costs. It is one of the rare PBM cases headed toward a jury and could influence how other local governments press similar claims.
According to First Alert 4, Circuit Judge Joseph A. Rathert has blocked off 30 days beginning March 1, 2027, for the trial. That scheduling move comes after years of procedural sparring, including earlier efforts by the PBMs to push the case into federal court.
County filings and a federal appeals summary spell out the stakes. Court documents attribute roughly 324 deaths and about 1,941 emergency-room visits to PBM practices and allege that companies used formularies and pricing tactics to shape which pain medications reached patients, according to Justia. The Eighth Circuit recently upheld a district court decision sending the case back to state court after finding that the PBMs’ removal was untimely, which keeps Jefferson County’s public-nuisance theory on track for a state-court jury unless that ruling is later overturned.
Case History And Early Rulings
Jefferson County first filed the lawsuit in 2020 under Missouri public-nuisance law, naming manufacturers, distributors, pharmacies and PBMs among dozens of defendants. A county press release at the time said the circuit court denied motions to dismiss and allowed discovery to move forward, setting the dispute on a trajectory toward trial, according to PR Newswire.
Why Plaintiffs Point To PBMs
The county contends PBMs prioritized rebates and contracts that kept opioids on plan formularies instead of tightening access, even as addiction and overdoses mounted. Those allegations landed in a national spotlight after a 2024 investigation reported that drugmakers paid PBMs to avoid strict limits on opioid prescribing, a story that involved rebate arrangements and internal documents. The investigation has been summarized in industry coverage, including Becker’s Hospital Review, which outlined how such deals allegedly worked.
What’s At Stake
If Jefferson County prevails at trial, it could win money beyond the opioid settlement funds it has already received through other litigation, potentially giving local officials more resources for treatment, prevention and related services. The county has already benefited from state-directed opioid settlements, but local reporting says a successful PBM case could produce a significantly larger payout and might also force operational changes inside the PBMs, according to First Alert 4. Before a jury ever hears testimony, expect months of pretrial motions and likely appeals.
Local Toll And Next Steps
Discovery is still underway, and county lawyers say they have obtained records that they believe show links between PBMs and opioid manufacturers. Local health numbers underscore why the county is pressing the case. Missouri Department of Health and Senior Services county fact sheets show that opioids, especially fentanyl and fentanyl metabolites, are the substances most often cited in Jefferson County overdose deaths, highlighting the public-health backdrop to the lawsuit, according to Missouri Department of Health and Senior Services. The trial is set to begin March 1, 2027, and whatever the jury decides could echo through other municipal lawsuits targeting PBMs across the country.
