Ardelyx, Inc. v. Robert F. Kennedy Jr.

CourtCourt of Appeals for the D.C. Circuit
DecidedJune 26, 2026
Docket24-5290
StatusPublished

This text of Ardelyx, Inc. v. Robert F. Kennedy Jr. (Ardelyx, Inc. v. Robert F. Kennedy Jr.) is published on Counsel Stack Legal Research, covering Court of Appeals for the D.C. Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ardelyx, Inc. v. Robert F. Kennedy Jr., (D.C. Cir. 2026).

Opinion

United States Court of Appeals FOR THE DISTRICT OF COLUMBIA CIRCUIT

Argued September 25, 2025 Decided June 26, 2026

No. 24-5290

ARDELYX, INC., ET AL., APPELLANTS

v.

ROBERT F. KENNEDY, JR., SECRETARY OF HEALTH AND HUMAN SERVICES, ET AL., APPELLEES

Appeal from the United States District Court for the District of Columbia (No. 1:24-cv-02095)

Michael E. Bern argued the cause for appellants. With him on the briefs were James E. McCollum, Jr., Amit K. Sharma, Christine C. Smith, Alexander G. Siemers, Delia Tasky, and Nicholas L. Schlossman.

Caroline D. Lopez, Attorney, U.S. Department of Justice, argued the cause for appellees. With her on the brief were Yaakov M. Roth, Acting Assistant Attorney General, Michael S. Raab, Attorney, and David L. Hoskins, Deputy Associate General Counsel for Litigation, U.S. Department of Health and Human Services. Anna O. Mohan, Attorney, U.S. Department of Justice, entered an appearance. 2 Before: CHILDS and PAN, Circuit Judges, and GINSBURG, Senior Circuit Judge.

Opinion for the Court filed by Senior Circuit Judge GINSBURG.

GINSBURG, Senior Circuit Judge: In 2008 the Congress directed the Secretary of Health and Human Services to “implement a payment system” that would provide a “single payment” for the reimbursement of “renal dialysis services” under Medicare, a federal health insurance program. See 42 U.S.C. § 1395rr(b)(14)(A)(i). In 2010 the Secretary, acting through the Centers for Medicare & Medicaid Services, defined “renal dialysis services” to include drugs with “only an oral form” — i.e., oral-only drugs — furnished for the treat- ment of end-stage renal disease. 42 C.F.R. § 413.171(3) (2011). In 2024 the CMS identified XPHOZAH, an oral-only drug manufactured by Ardelyx, Inc., as a renal dialysis service covered by the new payment system starting on January 1, 2025. Before then, XPHOZAH, along with other orally admin- istered drugs, had been reimbursed separately from the bundled payment under Medicare Part D.

Ardelyx, together with a healthcare research and advocacy organization and an organization representing the interests of kidney patients, challenged the CMS’s definition of “renal dialysis services” as including oral-only drugs and the identifi- cation of XPHOZAH as a renal dialysis service. * The district court dismissed Ardelyx’s complaint for lack of jurisdiction on the ground that the challenged actions were “identification[s] of renal dialysis services” within the meaning of 42 U.S.C.

* The Department of Health and Human Services, the Secretary of Health and Human Services, the CMS, and the Administrator of the CMS are all defendants and appellees in this lawsuit. For simplicity we refer to them collectively as the CMS. 3 § 1395rr(b)(14)(G), which bars judicial review of such actions by the Secretary. Ardelyx, Inc. v. Becerra (Ardelyx I), 757 F. Supp. 3d 37, 46-47 (D.D.C. 2024). We agree and affirm the dismissal of Ardelyx’s complaint.

I. Background

End-stage renal disease (ESRD) is a form of chronic kidney disease in which an individual’s kidneys can no longer function on their own. Patients with ESRD who do not receive a kidney transplant will die unless they receive dialysis treat- ment several times per week. Medicare covers the cost of dial- ysis for patients suffering from ESRD. See 42 U.S.C. §§ 426- 1, 1395rr(a).

A. Statutes and Regulations

In 1981 the Congress established a prospective payment system for the reimbursement of renal dialysis services in order to curb runaway costs. See Omnibus Budget Reconciliation Act of 1981, Pub. L. No. 97-35, § 2145, 95 Stat. 357, 799-800. Under this system, renal dialysis facilities and other providers of renal dialysis services would receive a prospective payment per treatment at a prescribed rate, regardless of their actual costs. See 48 Fed. Reg. 21254, 21260/3 (1983). This payment covered services including “routinely provided drugs, labora- tory tests, and supplies.” 75 Fed. Reg. 49030, 49032/1 (2010). A facility could retain any amount of the prospective payment that exceeded its actual costs. 48 Fed. Reg. at 21261/1. Certain items, such as erythropoiesis stimulating agents (ESAs), orally administered drugs, and most injectable drugs were reimbursed separately under Medicare Parts B or D.

The Congress believed this system would “encourage the more efficient delivery of dialysis services.” 42 U.S.C. § 1395rr(b)(7). The system, however, also gave facilities an 4 incentive to use the separately reimbursed items to treat ESRD because doing so allowed them to increase their total reim- bursement. By 2010 these separately reimbursed items accounted for “40 percent of total spending for outpatient maintenance dialysis.” 75 Fed. Reg. at 49032/2.

In order to bring that spending under control, the Congress enacted the Medicare Improvements for Patients and Providers Act of 2008, Pub. L. No. 110-275, § 153, 122 Stat. 2494, 2553. The MIPPA instructed the Secretary to “implement a payment system under which a single payment is made under this sub- chapter to a provider of services or a renal dialysis facility for renal dialysis services (as defined in subparagraph (B)) in lieu of any other payment.” 42 U.S.C. § 1395rr(b)(14)(A)(i). Subparagraph (B), § 1395rr(b)(14)(B), defines “renal dialysis services” as follows: 5 For purposes of this paragraph, the term “renal dialysis services” includes--

(i) items and services included in the composite rate for renal dialysis services as of December 31, 2010;

(ii) erythropoiesis stimulating agents and any oral form of such agents that are furnished to individuals for the treatment of end stage renal disease;

(iii) other drugs and biologicals that are furnished to individuals for the treatment of end stage renal disease and for which payment was (before the application of this paragraph) made separately under this subchapter, and any oral equivalent form of such drug or biological; and

(iv) diagnostic laboratory tests and other items and services not described in clause (i) that are furnished to individuals for the treatment of end stage renal disease. †

Subparagraph (B) goes on to exclude vaccines from the defini- tion of “renal dialysis services.”

The Congress also limited review of the Secretary’s actions with respect to the services covered by the new pay- ment system. As relevant here, the Congress provided that

† For consistency with the district court’s opinion, we refer to these categories as “subparts” of subparagraph (B). 6 “[t]here shall be no administrative or judicial review” of the Secretary’s “identification of renal dialysis services included in the bundled payment.” Subparagraph (G).

In 2009 the CMS published a notice of proposed rulemak- ing to implement the new prospective payment system. See 74 Fed. Reg. 49922. The CMS explained that it believed sub- part (B) (iii) required it to include in the bundled payment “all drugs and biologicals formerly payable under either Medicare Part B or Part D used to treat ESRD, regardless of the route of administration,” one effect of which was to include oral-only drugs. Id. at 49928/2-3.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

United States v. Turkette
452 U.S. 576 (Supreme Court, 1981)
Bowen v. Michigan Academy of Family Physicians
476 U.S. 667 (Supreme Court, 1986)
Commodity Futures Trading Commission v. Schor
478 U.S. 833 (Supreme Court, 1986)
Brown v. Gardner
513 U.S. 115 (Supreme Court, 1994)
United States v. Craft
535 U.S. 274 (Supreme Court, 2002)
Amgen Inc. v. Scully, Thomas
357 F.3d 103 (D.C. Circuit, 2004)
Palisades General Hospital Inc. v. Leavitt
426 F.3d 400 (D.C. Circuit, 2005)
Taniguchi v. Kan Pacific Saipan, Ltd.
132 S. Ct. 1997 (Supreme Court, 2012)
DCH Regional Medical Center v. Alex M. Azar II
925 F.3d 503 (D.C. Circuit, 2019)
Lomax v. Ortiz-Marquez
590 U.S. 595 (Supreme Court, 2020)
American Hospital Association v. Alex Azar, II
964 F.3d 1230 (D.C. Circuit, 2020)
FCC v. Prometheus Radio Project
592 U.S. 414 (Supreme Court, 2021)
Knapp Medical Center v. Hargan
875 F.3d 1125 (District of Columbia, 2017)
Ascension Borgess Hospital v. Xavier Becerra
61 F.4th 999 (D.C. Circuit, 2023)

Cite This Page — Counsel Stack

Bluebook (online)
Ardelyx, Inc. v. Robert F. Kennedy Jr., Counsel Stack Legal Research, https://law.counselstack.com/opinion/ardelyx-inc-v-robert-f-kennedy-jr-cadc-2026.