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The nation’s three largest drug distributors and two manufacturers have agreed with multiple states on a framework to resolve thousands of opioid cases with a settlement worth nearly $50 billion in cash and addiction treatments, according to three people familiar with the negotiations. The agreement would release AmerisourceBergen, Cardinal Health and McKesson Corporation, which together distribute about 90 percent of the country’s medicines, along with Johnson & Johnson and Teva, the Israel-based manufacturer of generic drugs, from a rapidly growing list of more than 2,300 lawsuits that they face in federal and state courts. (Hoffman, 10/16)

The distributors, accused of failing to halt and report suspicious drug orders, are pushing for a settlement to be agreed to before the trial begins Monday, one source said. The second source added that a sticking point was compensation for lawyers who typically are paid a percentage of settlements and represent many of the state and local plaintiffs. (10/16)

News of the discussions comes as jury selection was set to get underway Wednesday in Cleveland, before opening arguments in the federal trial Oct. 21. Some state attorneys general asked the judge in the case to delay the trial as they work on a settlement, but their request was denied, according to The Washington Post. Some of the defendants also filed a motion Wednesday to postpone the trial “due to eve-of-trial prejudicial publicity,” according to the case docket. The motion, though, is sealed. (Tirrell, 10/16)

The CEOs of McKesson Corp., Cardinal Health Inc. and two other companies seeking to settle legal claims over their handling of opioid painkillers were summoned to meet with a judge in hopes of hammering out a final deal, according to two people familiar with the matter. U.S. District Judge Dan Polster in Cleveland, who is overseeing the first federal trial over the U.S. opioid epidemic, demanded that the chief executive officers appear in his court on Friday to discuss their settlement proposals, according to the people, who asked not to be identified because the negotiations are confidential. (Feeley and Griffin, 10/17)

Use of opioid-alternative pain medications is surging as the U.S. tries to wean off the addictive painkillers, giving physicians concern that the opioid crisis will be substituted by a new prescription drug epidemic, according to a new report. Nearly two-thirds of primary-care physicians shared that sentiment while nearly three-quarters worry that chronic pain patients will turn to illicit drugs if they do not have access to prescription opioids, according to a new report from Quest Diagnostics, which polled 500 primary-care doctors and analyzed 4.4 million lab test results. (Kacik, 10/16)