Health Care & Reproductive Rights

OAKLAND — California Attorney General Bonta today joined a coalition of 21 attorneys general in filing an amicus brief with the U.S. Supreme Court defending a Colorado law that prohibits licensed health professionals from practicing conversion “therapy” on minors. Conversion “therapy,” also called sexual orientation or gender identity change efforts, are harmful and ineffective practices that attempt to change a person’s sexual orientation or gender identity. Colorado’s law prohibits licensed health professionals from practicing conversion therapy on children and youth. The statute was challenged in federal court by a licensed counselor who supports conversion therapy. Most recently, the U.S. Court of Appeals for the Tenth Circuit ruled that Colorado is entitled to regulate professional conduct, particularly where there is evidence of harm. The U.S. Supreme Court will hear oral argument in this case on October 7, 2025.

“In 2012, California became the first state to enact legislation — SB 1172 — banning conversion therapy on anyone under 18 years of age. Because conversion therapy doesn’t work; because it’s harmful to our youth; and because it’s fundamentally wrong,” said Attorney General Bonta. “With this important case now before the U.S. Supreme Court, we are proud to once again stand on the right side of history. We urge the justices to uphold Colorado’s law.”  

In the amicus brief, the attorneys general support Colorado’s ban on conversion therapy because it is not a safe or effective treatment for any condition, puts youth at risk of serious harms, including increased risks of suicide and depression, and falls below the standard of care for mental health practitioners. California is one of over 25 states that bans or restricts conversion therapy. The practice is repudiated by all leading medical and mental professional organizations, including the American Medical Association, the American Psychological Association, and the American Psychiatric Association.

The brief outlines why the court should reject the arguments against Colorado’s ban on the practice:

• The First Amendment does not shield dangerous and ineffective mental health practices from regulation, nor does it allow licensed providers to operate below a certain standard of care.
• Such bans are consistent with states’ long history of establishing and regulating professional standards of care.
• Striking down such a ban could create profound unintended consequences for states’ authority to regulate professional practices within their borders as they have throughout most of the nation’s history.

In filing the amicus brief, Attorney General Bonta joins the attorneys general of: Connecticut, Delaware, the District of Columbia, Hawai‘i, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Rhode Island, Vermont, Washington, and Wisconsin. Attorney General Bonta also filed an amicus brief in support of the Colorado law when it was pending at the U.S. Court of Appeals for the Tenth Circuit.  

A copy of the amicus brief can be found here. 

HOW TO GET HELP

If you identify as a member of the LGBTQ+ community and are thinking about suicide or struggling with your emotional health, we encourage you to reach out to one or more of the following resources and support services:

Trevor Project Lifeline: (866) 488-7386

The Trevor Lifeline provides support to LGBTQ+ youths and allies in crisis or in need of a safe and judgment-free place to talk.

Trans Lifeline: (877) 565-8860

Trans Lifeline provides peer support for the transgender community, and is run by and for trans people.

LGBT National Help Center

A national resource that provides LGBTQ+ community with free & confidential support and referral resources via phone, text, and chat.

Colors Youth

This non-profit organization provides free and unlimited mental health services for LGBTQ-identified youths ages 25 and younger.

National Alliance on Mental Illness (NAMI) LGBTQ+ Page

This page highlights the unique mental health needs of the LGBTQ+ community and includes hotlines and resources to help address those needs.

OAKLAND — California Attorney General Rob Bonta today announced conditionally approving the affiliations of Chapters Health System, Inc., a Florida not-for-profit hospice provider, with two nonprofit hospice providers in California. Chapters Health System, Inc. is seeking to expand its current operations, which are largely based on the East Coast, through the creation of “Chapters West Region,” a nonprofit hospice network covering California, Nevada, and Oregon. Specifically, in California, Chapters Health System, Inc. proposed affiliations with East Bay Integrated Care, Inc. (doing business as Hospice East Bay) and Hospice of Santa Cruz County. Both Hospice East Bay and Hospice of Santa Cruz County are longstanding providers of hospice and palliative care in their respective communities. Under California law, any transaction involving the sale, or transfer of control and governance of a nonprofit health facility, must secure the approval of the Attorney General’s Office. Today’s conditional approval represents the first-ever review involving nonprofit hospice providers by the Attorney General’s Office; the overwhelming majority of hospice providers are for-profit entities.  

“The hospice industry has increasingly attracted scrutiny, in part because of the potential for fraud and abuse. Earlier this month, I launched a new initiative aimed at addressing that very problem, and now, I am announcing that my office is, for the first time, conditionally approving transactions involving nonprofit hospice care providers,” said Attorney General Bonta. “The conditions we have developed are the result of a thorough review and serve the public interest by ensuring continued access to services for terminally ill patients and their loved ones. At the California Department of Justice, we remain committed to prioritizing oversight of the hospice industry.” 

For over 40 years, Hospice East Bay has served the counties of Contra Costa, Alameda, and Solano. Similarly, for over 40 years, Hospice of Santa Cruz County has served the counties of Santa Cruz and Monterrey. Under the two proposed affiliation agreements, Chapters Health System, Inc. would become the sole corporate member of Hospice East Bay and Hospice of Santa Cruz County. No sale or transfer of assets are contemplated, and both Hospice East Bay and Hospice of Santa Cruz County will retain separate governing bodies, nonprofit status, and irrevocable use of their assets, revenues, fundraising, gifts, and bequests.

After conducting a review of the proposed affiliations, Attorney General Bonta consented to the affiliations subject to numerous conditions. The conditions, each of which would be in place for five years, would facilitate the continued operation of Hospice East Bay and Hospice of Santa Cruz County. Highlights of the conditions include requiring the parties to: 

• Ensure that Hospice East Bay and Hospice of Santa Cruz County continue their nonprofit legacies in providing hospice and palliative care and remain continuously licensed as hospices, as well as continuously certified by The Centers for Medicare and Medicaid Services (CMS). 
• Offer employment to staff in good standing and honor existing employment agreements, as well as provide for appropriate staffing levels required for hospice licensure and certification. 
• Provide timely and effective patient triage and referral systems to prevent delays in patient care. 
• Create and maintain quality advisory committees at both Hospice East Bay and Hospice of Santa Cruz County to provide recommendations for quality of life and care of patients. The parties will provide an annual summary of those recommendations to the Attorney General.
• Use commercially reasonable efforts to continue to maintain specialty services at Hospice East Bay that are not otherwise covered by the traditional Medicare hospice benefit, including veteran’s programs, children’s grief programs, and music therapy. 
• Annually report on compliance with the conditions, provide information reasonably necessary for the Attorney General to monitor compliance, and consent to all conditions upon closings of the affiliations. 
• Reserve the Attorney General’s rights to enforce conditions and recover attorneys’ fees. 

The California Department of Justice’s Healthcare Rights and Access Section (HRA) works proactively to increase and protect the affordability, accessibility, and quality of healthcare in California. HRA’s attorneys monitor and contribute to various areas of the Attorney General’s healthcare work, including nonprofit healthcare transactions; consumer rights; anticompetitive consolidation and conduct in the healthcare market; anticompetitive drug pricing; privacy issues; civil rights, such as reproductive rights and LGBTQ healthcare-related rights; and public health work on tobacco, e-cigarettes, and other products.   

A copy of the conditional approval letter is available here.

OAKLAND — California Attorney General Rob Bonta today sued the Trump Administration over the sweeping budget reconciliation law (“Big Beautiful Bill”), specifically the “Defund Provision,” signed by President Donald Trump this month. This provision, which targets Planned Parenthood, is a direct attack on the healthcare access of millions of low-income Americans, disproportionally affecting women, LGBTQ+ individuals, and communities of color. This provision specifically blocks Medicaid reimbursements for essential healthcare services, such as cancer screenings, birth control, and STI testing, at Planned Parenthood health centers. Attorney General Bonta, co-leading a coalition of 22 attorneys general and one governor, asks the court to enjoin the Trump Administration from implementing this devastating and unlawful provision, which will lead to widespread disruptions in preventative care and increase healthcare costs, if allowed to stand. They also assert that the states should not be co-opted into executing this unconstitutional provision. 

“Let me be clear: Federal funds don't pay for abortions. This provision is purely retaliation against Planned Parenthood for its constitutionally protected advocacy for abortion care. The President and Congress are implementing a cruel, backdoor abortion ban through this provision, putting their political agendas over people’s lives,” said Attorney General Rob Bonta. “This will wreak havoc on healthcare services from cancer screenings to STI testing for millions of Americans who have nowhere else to turn. California will continue to lead as a reproductive freedom state — and we will be there every single time the federal administration tries to strip away your healthcare rights and ignore the rule of law.”

“PPAC is grateful for the support of California Attorney General Rob Bonta and other state attorneys general to ensure that patients who rely on Medicaid can continue to access the full range of sexual and reproductive health care services at Planned Parenthood health centers. The Defund Provision is a direct attack by the Trump administration and the GOP-led Congress on not only Planned Parenthood, but also on Reproductive Freedom States like California, where we value and prioritize access to reproductive health care,” said Planned Parenthood Affiliates of California CEO and President Jodi Hicks. “Planned Parenthood health centers are a critical part of reproductive health care access in California, which is why the impacts of this federal defund will reverberate throughout the state – cutting off access to live-saving health care services for our most vulnerable communities. Despite the challenges we face, PPAC will continue to fight back against this unjust defund, and work with our state leaders to ensure that every Californian can access the care they need, when they need it, no matter what.”

The “Big Beautiful Bill,” is a sweeping Republican-led law signed by the President last month. Among its many provisions, one of the most detrimental sections is a clause that blocks federal Medicaid funding for essential medical services such as cancer screenings, birth control, STI testing, and wellness exams provided at Planned Parenthood health centers. Defunding Planned Parenthood threatens at least 200 health centers nationwide, affecting healthcare for more than 1.1 million people, many of whom are unlikely to be able to receive care elsewhere. Despite claims by Republican lawmakers that other healthcare centers can absorb these patients, recent findings from the Guttmacher Institute indicate that alternative locations do not have the capacity to serve the number of Americans who currently rely on Planned Parenthood for their healthcare.

Planned Parenthood Federation of America filed a lawsuit against the Trump administration challenging the prohibited Medicaid reimbursements. But last week, following the expiration of a temporary restraining order enjoining the Defund Provision, most Planned Parenthood clinics nationwide became cut off from Medicaid funding. In California, Planned Parenthood, which is the largest abortion provider in the state, lost all $300 million of its federal funding. This decision jeopardized the stability of the Planned Parenthood network in California, threatening its ability to continue operating 109 clinics, serving about 700,000 patients each year. Already, five Planned Parenthood clinics were forced to close their doors last week. Nearly 80% of those patients use Medi-Cal, the state version of the federal Medicaid program for people with low incomes or disabilities. While yesterday the court granted Planned Parenthood’s injunction in full, concluding that the Defund Provision violates the First Amendment and Equal Protection clause, as well as the prohibition on Bills of Attainder in the U.S. Constitution, the attorneys general remain committed to ensuring full relief.

In today’s filing, Attorney General Bonta and the coalition argue that the Defund Provision, which prohibits Medicaid reimbursements for Planned Parenthood, is impermissibly ambiguous and violates Congress’ Spending Clause power. They highlight that the provision is likely to increase health risks, including delayed diagnoses of STIs and cancer and increased unintended pregnancies, which will result not only in widespread and devastating effects on the health of our most vulnerable residents, but also increased costs of $30 million over the next five years and $52 million over the next ten years in Medicaid programs. The coalition urges the court to enjoin the Trump Administration from implementing the provision in order to prevent the tremendous harm this will have on public health and welfare of their states, as well as the increased costs to the states. 

In filing the lawsuit, Attorney General Bonta along with the attorneys general of Connecticut and New York, lead the attorneys general of Colorado, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, North Carolina, Oregon, Rhode Island, Vermont, Washington, Wisconsin, and the District of Columbia, as well as the state of Pennslyvania. 

A copy of the lawsuit is available here. 

OAKLAND — California Attorney General Rob Bonta today issued a statement following the U.S. Supreme Court’s decision in Planned Parenthood South Atlantic v. Medina denying Medicaid recipients' individual right to receive care from the qualified providers of their choice, including Planned Parenthood. In a 6-3 opinion, the U.S. Supreme Court ruled that Medicaid beneficiaries do not have a private right of action to obtain assistance from any institution that is “qualified to perform the service or services required” under the Medicaid Act’s free-choice-of-provider provision  because the any-qualified-provider provision, passed by Congress, does not clearly and unambiguously confer individual rights enforceable under §1983. The case began when the state of South Carolina unlawfully terminated Planned Parenthood South Atlantic’s (Planned Parenthood) participation in Medicaid only because the organization performed abortions outside of the Medicaid program. As a result of the termination, Planned Parenthood immediately had to begin turning away Medicaid patients.

“Congress expressly granted patients the right to choose a qualified doctor or provider they trust while seeking medical care. Today’s decision got it wrong: It strips choice out of the hands of patients, and allows politicians to block patients from making their own decisions about their own healthcare,” said Attorney General Bonta. “The impacts of this decision are likely to harm real people, especially low-income residents of South Carolina and other Medicaid beneficiaries who turn to Planned Parenthood for critical services, including physical exams, pregnancy testing and counseling, and screening for conditions such as diabetes, depression, and high blood pressure. In California, we will continue to defend patients’ access to choose providers they trust, including qualified providers like Planned Parenthood.”  

As part of a coalition of 17 attorneys general, Attorney General Bonta previously filed an amicus brief with the U.S. Supreme Court in support of Medicaid recipients' individual right to receive care from the qualified providers of their choice, including Planned Parenthood.

OAKLAND — California Attorney General Rob Bonta today joined a bipartisan coalition of 39 attorneys general in urging Congressional leaders to pass the Youth Substance Use Prevention and Awareness Act, a bipartisan bill that would authorize federal grant funding for public service announcement (PSA) campaigns aimed at reducing youth substance use. In addition, the bill would promote innovation by supporting youth-led PSA contests — an approach that not only engages young people directly but also encourages peer-to-peer communication, which is shown to be highly effective. 

“Youth substance use is a serious problem — one that affects all communities, no matter their politics,” said Attorney General Bonta. “I’m joining a bipartisan coalition of attorneys general in supporting the Youth Substance Use Prevention and Awareness Act because it can help to save lives. I urge Congress to pass this bill as quickly as possible.”

In the letter to Senate Majority Leader John Thune, Senate Minority Leader Chuck Schumer, House Speaker Mike Johnson, and House Minority Leader Hakeem Jeffries, the attorneys general emphasize that: 

• They are deeply involved in efforts to address substance use and addiction from every angle — criminal enforcement, civil litigation, consumer protection, public education, and prevention. 
• The earlier an individual begins using substances, the likelier they are to develop substance use disorders later in life. That is why prevention, particularly among youth, remains an effective tool in addressing this public health and public safety crisis. 
• By requiring annual reports on the content, reach, and outcomes of the funded campaigns, the legislation will ensure transparency, accountability, and effectiveness. 

In sending today’s letter, Attorney General Bonta joins the attorneys general of New Hampshire, Connecticut, New York, South Dakota, Alaska, Arizona, Colorado, Delaware, Georgia, Hawaii, Illinois, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Mexico, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, American Samoa, the District of Columbia, the Northern Mariana Islands, and the U.S. Virgin Islands.

A copy of the letter can be found here.

Court order continues blocking termination of federal funds appropriated by Congress

OAKLAND — California Attorney General Rob Bonta today released a statement in response to the U.S. District Court for the District of Rhode Island’s decision to issue a preliminary injunction that continues blocking the unlawful termination of $11 billion in critical public health funding by the Trump Administration’s U.S. Department of Health and Human Services (HHS) and HHS Secretary Robert F. Kennedy, Jr. Among its findings, the court concluded that the federal government had “clearly usurped Congress’s authority to spend and allocate funds.” The preliminary injunction is in effect with respect to the plaintiff states and the District of Columbia until further order by the court. 

“Left unchallenged, California alone would lose more than $972 million from these illegal cancellations by HHS. We will not allow that to happen,” said Attorney General Bonta. “We are pleased that, after granting our motion for a temporary restraining order last month, the court has now issued a preliminary injunction that ensures this critical federal funding can continue flowing to our state and local public health agencies while our litigation proceeds. Critically, the court also noted that we are likely to succeed on the merits of our claims.” 

On April 1, Attorney General Bonta announced co-leading a coalition of 23 states and the District of Columbia in filing a lawsuit against the Trump Administration’s HHS and HHS Secretary Robert F. Kennedy, Jr. over the unlawful termination of public health funding. Beginning on March 24, 2025, HHS abruptly, with no advance notice or warning, issued termination notices to state and local public health agencies across the country, purporting to end federal funding for grants that provide essential support for a wide range of urgent public health needs, including identifying, tracking, and addressing infectious diseases; ensuring access to immunizations; and modernizing critical public health infrastructure. 

Filed in the U.S. District Court for the District of Rhode Island, the lawsuit alleges that the termination notices are unlawful in several ways under the Administrative Procedure Act. The federal funding was appropriated by Congress to ensure the United States is better prepared for future public health threats. According to the Trump Administration, funding for the grants is “no longer necessary” because the grants were appropriated through one or more COVID-19 related laws, and the COVID-19 pandemic is over. The coalition secured the temporary restraining order on April 3.

A copy of the court’s order can be found here.

OAKLAND — California Attorney General Rob Bonta today issued the following statement in response to the Humboldt County Superior Court’s decision to deny Providence St. Joseph Hospital’s (Providence) attempt to dismiss the Attorney General’s lawsuit, which alleges that the hospital violated multiple laws by refusing to provide emergency abortion care to people experiencing obstetric emergencies. Located in Eureka, California, Providence is the only available option for women in Humboldt County to seek emergency abortion care.  

“There was no legal basis to dismiss our lawsuit against Providence, and we are grateful that the court agreed with us on every ground,” said Attorney General Bonta. “California is committed to protecting reproductive rights and let me be clear: that includes emergency abortion care. For those who are unfamiliar with Anna Nusslock’s harrowing story and Providence’s refusal to treat her, I encourage you to watch this video. I’m thinking of her today. Denying emergency abortion care to pregnant patients who need it is both traumatic and unlawful under multiple laws. My team and I look forward to seeing this case through and holding Providence accountable.”  

In its demurrer, or attempt to dismiss the Attorney General’s lawsuit, Providence argued that California's Emergency Services Law (the state-level analogue to the federal EMTALA statute) infringed on its religious right to free expression and that the State had not sufficiently pled a claim under the Unruh Civil Rights Act or the Unfair Competition Law, among other things. The court overruled Providence’s demurrer on those grounds, and all others. 

On October 29, 2024, Attorney General Bonta secured a stipulation from Providence that ensures the hospital follows California law while the case proceeds. On February 14, 2025, the Humboldt County Superior Court held oral argument on Providence’s demurrer and took the matter under submission.  

A copy of the court’s decision can be found here.

17th lawsuit against Trump Administration asks court to block implementation of “Make America Healthy Again” Directive

OAKLAND — California Attorney General Rob Bonta today joined a coalition of 20 attorneys general in filing a lawsuit against the Trump Administration challenging the unlawful mass firing of roughly 10,000 full-time U.S. Department of Health and Human Services (HHS) employees, the consolidation of 28 HHS divisions into 15 divisions, and the closing of half of HHS’s ten regional offices — including one in San Francisco. Announced on March 27, these actions were part of HHS Secretary Robert F. Kennedy, Jr.’s Directive to “Make America Healthy Again” (MAHA Directive). In their lawsuit, the attorneys general argue that the MAHA Directive is arbitrary and capricious and contrary to law in violation of the Administrative Procedure Act (APA), is beyond the scope of presidential power, and violates the Appropriations Clause and Separation of Powers doctrine of the U.S. Constitution. Accordingly, they ask the U.S. District Court for the District of Rhode Island to declare the MAHA Directive unconstitutional and illegal, and to block its implementation in order to undo the mass firings, reverse the illegal reorganization, and restore the critical health services that millions of Americans depend on.  

“The Trump Administration does not have the power to incapacitate a department that Congress created, nor can it decline to spend funds that were appropriated by Congress for that department. That’s why my fellow attorneys general and I are taking the Trump Administration to court — HHS is under attack, and we won’t stand for it,” said Attorney General Bonta. “Our States, and our people, are facing real harms as a result of the MAHA Directive. We look forward to making our case in court.”   

Congress has passed dozens of laws for HHS to enforce and authorized HHS to spend about $1.8 trillion in 2024 alone because, in Congress’s judgment, the work of the Department is that critical. The MAHA Directive has had devastating consequences on HHS’s core mission to protect the health and well-being of all Americans. Following the MAHA Directive, work across several agencies within HHS came to a halt overnight. Further, the MAHA Directive layoffs compounded staff departures through a series of so-called “buy-out” offers, meaning that all told, in the last three months, HHS has lost roughly 20,000 of the 82,000 employees who were working at the agency as of January 2025. In addition, workers across the country can no longer reliably access N95 masks following the closure of the nation’s only federal mask approval laboratory. Key Centers for Disease Control and Prevention (CDC) infectious disease laboratories have also been shuttered, including those responsible for testing and tracking measles, effectively halting the federal government’s ability to monitor the disease nationwide.

In their lawsuit, the attorneys general argue that: 

• Long before he was nominated by President Trump to lead HHS, Secretary Kennedy had a history of spinning conspiracy theories about the Department and advocating for the evisceration of the Department’s statutorily mandated work promoting public health.
• The MAHA Directive has caused substantial harm to their States. Among other things, the regional staff who were fired helped to provide critical support to early childhood programs within the Administration for Children and Families like Head Start. If Head Start programs in their States are forced to pause operations or close, hundreds of thousands of children (and their families) would be left without child care, early education, and health supports, which would inevitably impact and strain their States’ social support programs.
• The MAHA Directive has disabled HHS from performing its regulatory and enforcement functions. For example, the Office of Compliance and Enforcement within the Center for Tobacco Products — a subagency within HHS — typically filed more than 100 complaints a week seeking civil monetary penalties against retailers that repeatedly sold tobacco to customers under 21, in violation of federal law. The MAHA Directive wiped out the Office of Compliance and Enforcement, straining the ability of remaining staff to seek penalties. 

In filing today’s lawsuit, Attorney General Bonta joins the attorneys general of Arizona, Colorado, Connecticut, Delaware, Hawai’i, Illinois, Maine, Michigan, Maryland, Minnesota, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington, Wisconsin, and the District of Columbia. 

A copy of the complaint can be found here.

Bipartisan coalition of attorneys general writes that federal action is needed to protect consumers and small businesses

OAKLAND — California Attorney General Rob Bonta today joined a bipartisan coalition of 39 attorneys general in urging the leaders of the U.S. House of Representatives and U.S. Senate to enact a law that prohibits Pharmacy Benefit Managers (PBMs), their parent companies, or affiliates from owning or operating pharmacies. Created in the late 1960s to process claims for drug companies, PBMs were supposed to help consumers access low-cost pharmaceutical care through negotiated volume-pricing discounts, generic substitution, manufacturer rebates, and other tools. However, the attorneys general write, PBMs have overtaken the market and now wield outsized power to reap massive profits at the expense of consumers and local community pharmacies. In particular, PBMs’ use of affiliated pharmacies — pharmacies owned by either the PBM itself or the PBM’s parent company — has exacerbated the problem of manipulated prices, the growth of pharmacy deserts, and the unavailability of certain prescription medications. 

“PBMs’ priority is not consumers, but rather their own bottom line. They must be reined in,” said Attorney General Bonta. “Drug prices have skyrocketed in recent years, and PBMs have exacerbated the problem. To protect consumers and small businesses, we need more competition — not less — in the marketplace. A federal law prohibiting PBMs, and their parent companies or affiliates, from owning or operating pharmacies is long overdue, and I’m proud to be part of a bipartisan coalition of attorneys general that is calling on Congressional leadership to make it a reality.”

In the letter, the attorneys general emphasize that:

• Over the past few decades, horizontal consolidation and vertical integration have transformed PBMs from useful administrative service providers into market-dominating behemoths that control the industry. Horizontal consolidation here is the merger of competing PBMs and vertical consolidation here is the acquisition of pharmacies by PBMs at the expense of competitors of those PBMs and pharmacies.
• The three largest PBMs — CVS Caremark, Optum Rx, and Express Scripts — process 80% of the nation’s prescriptions and bring in 70% of the specialty drug revenue. Furthermore, each of the top six PBMs operate their own affiliated pharmacies, while five of the top six are also a part of parent conglomerates that operate insurance companies and health care clinics.
• In addition to owning pharmacies, PBMs also contract with non-affiliated pharmacies, including independent pharmacies, to create pharmacy networks that control where their members can get their drugs and at what prices. This creates the situation where the PBMs — through ownership of affiliated pharmacies — are contracting with and have power over their own pharmacies’ competition. The PBMs then use their place as middlemen to exert this power in ways that harm independent pharmacies, forcing these small businesses to accept contractual terms that are “confusing, unfair, arbitrary, and harmful” and ultimately causing them to go out of business.
• Over the course of the last decade, approximately 10% of rural independent pharmacies in the United States have closed. The closure of independent pharmacies, and the community services they provide, is felt strongly by consumers — especially those in rural or otherwise underserved areas who are left with dwindling access to retail pharmacies that are ever farther away.

In sending today's letter, Attorney General Bonta joins the attorneys general of Alaska, American Samoa, Arkansas, Arizona, California, Delaware, the District of Columbia, Hawaii, Illinois, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah, Vermont, Virgin Islands, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

A copy of the letter can be found here.

OAKLAND — California Attorney General Rob Bonta today announced a multistate settlement in principle with pharmaceutical company Mylan Inc. (Mylan) that will deliver up to $335 million nationwide to help combat the opioid crisis. Mylan, which is now a part of Viatris, has manufactured and sold a variety of opioids since 2005, including generic fentanyl patches, oxycodone, hydrocodone, and buprenorphine products. The attorneys general allege Mylan deceptively promoted its products as less prone to abuse despite knowing for years that many of its opioid products — particularly its fentanyl patches — were actually more vulnerable to abuse. The company fueled the opioid crisis by marketing directly to doctors, leading to dangerous overprescribing and diversion of its opioids into the illegal drug market. 

“Companies and individuals who fueled the opioid crisis must be held accountable. With today’s announcement, the California Department of Justice is continuing to deliver results,” said Attorney General Bonta. “The opioid crisis does not distinguish between Democrats or Republicans – it has affected people from all walks of life. I’m proud to have worked on this with a bipartisan coalition of attorneys general.”   

Under the multistate settlement in principle, Mylan will pay up to $335 million to participating states over nine years.

This settlement in principle was negotiated by the attorneys general of California, Illinois, Massachusetts, New York, North Carolina, Oregon, Tennessee, Utah, and Virginia in coordination with the attorneys general of Colorado, Delaware, Georgia, Idaho, Iowa, and Vermont.