The State of Alaska v. Express Scripts, Inc., 774 F.Supp.3d 1150

The State of Alaska brought suit against Express Scripts, a major Pharmacy Benefits Manager (PBM), for allegedly contributing to the opioid crisis in Alaska through its design of drug formularies, failure to implement controls to prevent opioid abuse, and direct mail-order dispensing of opioids.
Alaska alleges Express Scripts colluded with opioid manufacturers to promote opioid sales, failed to act on data indicating abuse, and aided misleading marketing, amplifying opioid-related harm within the state.
The action arose in state court (with public nuisance and unfair trade practices claims), then removed to federal district court, with a later addition of a federal RICO claim.
Express Scripts moved to dismiss the RICO claim as time-barred, substantively deficient, and precluded as to equitable relief; it also sought to stay discovery pending resolution of a similar state court appeal.
The court held oral argument and issued a decision granting in part and denying in part the motion to dismiss and fully denying the motion for stay, allowing certain claims to proceed to discovery.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Availability of Equitable Relief under RICO	State may seek equitable relief (including injunction) under RICO	Wollersheim bars private civil RICO plaintiffs from seeking equitable relief	Equitable relief (including injunction) not available under Ninth Circuit law to plaintiff; dismissed to that extent
Timeliness of RICO Claim	Invokes fraudulent concealment and separate-accrual doctrine; factual questions remain	Statute of limitations expired—State knew or should have known injury earlier	Not time-barred on the face; fraudulent concealment adequately pleaded; motion to dismiss denied on this ground (further amendment allowed re: separate-accrual)
Cognizable RICO Injury	Extraordinary public expenses should be recoverable under RICO; state also incurred market-based costs	Only ordinary government service expenses alleged; per Canyon County, not RICO injuries	Dismissed as to increased personnel/service costs; allowed to proceed as to certain market-based injuries (e.g., naloxone purchases), and possibly more after discovery
Motion to Stay Discovery	Litigation should proceed; stay would prejudice state and be inefficient	Stay warranted pending relevant state court decision	Denied — stay would cause undue delay and inefficiency, little hardship to defendant

Ashcroft v. Iqbal, 556 U.S. 662 (pleading standard for motions to dismiss)
Bell Atl. Corp. v. Twombly, 550 U.S. 544 (plausibility standard for pleadings)
Holmes v. Sec. Inv’r Prot. Corp., 503 U.S. 258 (RICO proximate cause requirement)
Reves v. Ernst & Young, 507 U.S. 170 (RICO participation/"operation or management" test)
Boyle v. United States, 556 U.S. 938 (RICO enterprise requirements—association-in-fact)
Sedima, S.P.R.L. v. Imrex Co., 473 U.S. 479 (elements of civil RICO)
Canyon Cnty. v. Syngenta Seeds, Inc., 519 F.3d 969 (government entity not injured in its property by providing services—even if extraordinary—for RICO purposes)
Landis v. N. Am. Co., 299 U.S. 248 (inherent court power to stay proceedings)
Clinton v. Jones, 520 U.S. 681 (standards for issuing stay in federal court)
Conmar Corp. v. Mitsui & Co. (U.S.A.), 858 F.2d 499 (fraudulent concealment for statute of limitations purposes)