How Attorneys General Are Shaping National Health Policy Debates

Key Takeaways

• Attorneys general have become a notable force in shaping health policy at both the state and federal level, using litigation, coalition letters, and enforcement actions to influence outcomes across a range of issues.
• The Purdue/Sackler opioid settlement, which went into effect May 1, delivered $7.4 billion across 55 states and territories. Beyond accountability, opioid settlements like this one have created a meaningful source of funding for remediation efforts.
• On PBM reform, a bipartisan coalition of 45 attorneys general recently signed a letter supporting proposed federal rulemaking to increase PBM transparency, building on earlier efforts to push Congress to ban PBMs from owning pharmacies.
• Reproductive health has become a flashpoint, with Republican attorneys general challenging FDA rules around mifepristone while Democratic attorneys general push back through amicus briefs and coalition efforts to preserve access.
• Medicaid fraud enforcement is also picking up, with attorneys general in Texas and Florida recently launching new investigations and task forces as program integrity becomes a growing federal and state priority.

---

From opioid settlements to Medicaid oversight, attorneys general are exercising growing influence over health policy. Attorneys general are playing an increasingly important role in health policy as they shape the regulatory, enforcement, and litigation landscape across a growing range of issues.

Opioid Epidemic Response and Multibillion Dollar Settlements

Over the past decade, attorneys general have been central to the response to the opioid epidemic by pursuing investigations and legal action against industry actors, securing billions of dollars in settlements, and increasing oversight. Most recently, the Purdue/Sackler opioid settlement went into effect on May 1, which yielded $7.4 billion across all 55 eligible states and territories. In addition to accountability, these settlements have also created a significant source of funding for opioid remediation efforts across states.

Drug Pricing and Pharmacy Benefit Manager Reform Efforts

Attorneys general have also been active on drug pricing and pharmacy benefit manager (PBM) reform. In 2025, a bipartisan group of 39 attorneys general sent a letter to Congress urging them to pass legislation to prohibit PBMs from owning pharmacies. Engagement has continued this year with a bipartisan coalition of 45 attorneys general recently signing onto a letter expressing support for proposed federal Department of Labor rulemaking to increase PBM transparency.

Reproductive Health and Medication Abortion Litigation

Reproductive health is another area where attorneys general are shaping national policy debates, particularly around medication abortion.

State Challenges to FDA Mifepristone Regulations

Over the past year, several Republican attorneys general have challenged U.S. Food and Drug Administration (FDA) approval and regulation of mifepristone. At the same time, some Republican attorneys general are pursuing criminal and civil actions against providers accused of mailing abortion medication into states with abortion bans, further testing the limits of interstate access and shield laws.

Fifth Circuit Ruling and Supreme Court Emergency Appeal

This activity escalated in recent weeks when, in response to litigation filed by Louisiana Attorney General Liz Murrill (R), the U.S. Court of Appeals for the Fifth Circuit enjoined a 2023 FDA rule change that removed the in-person dispensing requirement and authorized telehealth prescriptions and mail-order dispensing of the drug. The U.S. Supreme Court subsequently issued an order putting the stay on hold for a week and preserving access while the Court considers an emergency appeal by the drug's manufacturer. In response, 22 Democratic attorneys general filed an amicus brief urging the Court to maintain access.

Medicaid Fraud Enforcement and Program Integrity Initiatives

Medicaid fraud is another key area to watch. Attorneys general typically oversee state Medicaid Fraud Control Units or similar oversight entities, which investigate and prosecute fraud. As program integrity has emerged as a federal priority, attorneys general are also expanding their enforcement activity. In April, Texas Attorney General Ken Paxton (R) announced investigations into dozens of Medicaid providers utilizing claims data released by the federal Department of Government Efficiency. Similarly, Florida Attorney General James Uthmeier (R) recently launched a Public Assistance Fraud Task Force to coordinate legal strategy and strengthen prosecution efforts.

Track Health Care Policy

The ever-evolving state health policy landscape will continue to influence how health care organizations make business decisions. MultiState's team pulls from decades of expertise to help you effectively navigate and engage. MultiState's team understands the issues, knows the key players and organizations, and we harness that expertise to help our clients effectively navigate and engage on their policy priorities. We offer customized strategic solutions to help you develop and execute a proactive multistate agenda focused on your company's goals. Learn more about our Health Care Policy Practice.