AstraZeneca Pharmaceuticals LP v. Secretary United States Department of Health and H

137 F.4th 116
Court of Appeals for the Third Circuit·Decided May 8, 2025·No. 24-1819·Published·Cited by 5 cases

Opinion

PRECEDENTIAL

UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT

No. 24-1819

ASTRAZENECA PHARMACEUTICALS LP;

ASTRAZENECA AB, Appellants

v.

SECRETARY UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES; ADMINISTRATOR CENTERS FOR MEDICARE & MEDICAID SERVICES

On Appeal from the United States District Court for the District of Delaware (D.C. No. 1:23-cv-00931)

District Judge: Honorable Colm F. Connolly

Argued on October 30, 2024

Before: HARDIMAN, PHIPPS, and FREEMAN, Circuit Judges

(Opinion filed: May 8, 2025)

Catherine E. Stetson [ARGUED] Susan M. Cook Danielle Desaulniers Stempel Claire Adkins Rhodes Hogan Lovells US LLP 555 Thirteenth Street NW Washington, D.C. 20004 (202) 637-5600 Counsel for Appellants

Lindsey Powell [ARGUED] Steven A. Myers Catherine M. Padhi David L. Peters Michael S. Raab Bridgette L. Kaiser Anant Kumar Matthew A. Campbell United States Department of Justice, Appellate Section Room 7259 950 Pennsylvania Avenue NW Washington, DC 20530 Counsel for Appellees

Michael D. Lieberman Fairmark Partners 1001 G Street NW Suite 400 East Washington, DC 20001 Counsel for Amicus Patients for Affordable Drugs

Ananda V. Burra Robin F. Thurston Democracy Forward Foundation P.O. Box 34553 Washington, DC 20043 Counsel for Amici American Public Health Association, American College of Physicians, American Geriatrics Society, American Society of Hematology, and Society of General Internal Medicine

Charles L. Becker Kline & Specter 1525 Locust Street 19th Floor Philadelphia, PA 19102 Counsel for Amici Senators Amy Klobuchar, Peter Welch, Tammy Baldwin, Richard Blumenthal, Sherrod Brown, Catherine Cortez Mastro, Richard Durbin, John Fetterman, John Hickenlooper, Jack Reed, Jacky Rosen, Jeanne Shaheen, Debbie Stabenow, Chris Van Hollen, and Elizabeth Warren

Hannah W. Brennan Sophia K. Weaver Hagens Berman Sobol Shapiro One Faneuil Hall Square, 5th Floor Boston, MA 02109

Jamie Crooks Fairmark Partners 400 7th Street NW Suite 304 Washington, DC 20004 Counsel for Amici Center for American Progress, Century Foundation, UnidosUS Action Fund, and National Association for the Advancement of Colored People

Maame A. Gyamfi AARP Foundation Litigation B4-377 601 E Street NW Washington, DC 20049 Counsel for Amici AARP, AARP Foundation, Center for Medicare Advocacy, Justice in Aging, and Medicare Rights Center

Alyssa H. Card Margaret Dotzel William B. Schultz Zuckerman Spaeder 1800 M Street NW Suite 1000 Washington, DC 20036 Counsel for Amici Stuart Altman, Robert Berenson, Donald Berwick, David Blumenthal, Francis J. Crosson, Paul Ginsburg, Marilyn Moon, and Bruce Vladeck

Deepak Gupta Gupta Wessler 2001 K Street NW Suite 850 North Washington, DC 20006 Counsel for Amici Richard G. Frank, Fiona M. Scott Morton, Aaron S. Kesselheim, Gerard F. Anderson, Rena M. Conti, David M. Cutler, and Jack Hoadley

OPINION OF THE COURT

FREEMAN, Circuit Judge.

The Inflation Reduction Act of 2022 (“IRA”) created the Drug Price Negotiation Program (“Negotiation Program”). The Negotiation Program directs the Centers for Medicare & Medicaid Services (“CMS”) to negotiate prices for certain

drugs that have resulted in high expenditures to Medicare. To implement that statutory directive, CMS issued guidance explaining how it would select the qualifying drugs for 2026— the first year of the Negotiation Program. CMS then selected the drugs that are subject to negotiation. One of the selected drugs is Farxiga, which is manufactured by AstraZeneca.1

AstraZeneca sued the Secretary of the Department of Health and Human Services and CMS’s Administrator (collectively, “the government”) to challenge the Negotiation Program and portions of CMS’s guidance. AstraZeneca claims that the Negotiation Program deprives it of procedural due process and that two provisions of CMS’s guidance violate the Administrative Procedure Act (“APA”).

The District Court determined that AstraZeneca failed to state a due process violation to challenge the Negotiation Program and lacks standing to pursue its APA claims. Accordingly, the District Court entered judgment in favor of the government. For the following reasons, we will affirm the District Court’s judgment.

I

Medicare is a federal medical insurance program for people ages sixty-five and older and for younger people with certain disabilities. See 42 U.S.C. § 1395 et seq. Medicaid is a joint federal and state program that provides medical coverage for people with limited incomes. See id. § 1396 et seq. “Through Medicare and Medicaid, [the federal government] pays for almost half the annual nationwide

1 We refer to AstraZeneca Pharmaceuticals LP, and AstraZeneca AB collectively as “AstraZeneca.”

spending on prescription drugs.” Sanofi Aventis U.S. LLC v. U.S. Dep’t of Health & Hum. Servs., 58 F.4th 696, 699 (3d Cir. 2023) (citing Cong. Budget Off., Prescription Drugs: Spending, Use, and Prices 8 (2022)).

Medicare is divided into Parts, two of which (Parts B and D) are relevant here. Part B is a voluntary supplemental insurance program that covers outpatient care, including certain prescription drugs that are typically administered by a physician. See 42 C.F.R. § 410.28. Part D “is a voluntary prescription drug benefit program that subsidizes the cost of prescription drugs and prescription drug insurance premiums for Medicare enrollees.” United States ex rel. Spay v. CVS Caremark Corp., 875 F.3d 746, 749 (3d Cir. 2017). Part D works through prescription drug plans operated by private insurance companies that it calls “sponsors.” Sponsors then work with subcontractors, including pharmacy benefit managers, who handle administrative tasks and process claims. See id. Those subcontractors in turn contract with the pharmacies that dispense prescription drugs to Medicare beneficiaries. See id.

When Congress enacted Medicare Part D in 2003, it included a “non-interference” provision. That provision states that CMS “may not interfere with the negotiations between drug manufacturers and pharmacies and . . . sponsors” and “may not institute a price structure for the reimbursement of covered part D drugs.” 42 U.S.C. § 1395w-111(i)(1), (3) (2003). Nineteen years later, when Congress enacted the IRA, it created an exception to the non-interference provision: the Negotiation Program directs CMS to “negotiate . . . maximum fair prices” for certain drugs, id. § 1320f(a)(3), subject to price ceilings derived from the price on the private market, id. § 1320f-3(c). Each selected drug’s “maximum fair price”

applies beginning in a given drug-pricing period (a period of one calendar year), the first of which is 2026, until the drug is no longer eligible for negotiation or the price is renegotiated. Id. §§ 1320f(b)(1)–(2), 1320f-1(c), and 1320f-3(f).

The Negotiation Program sets out a two-phase process for each drug-pricing period. First, CMS identifies the drugs subject to negotiation. Second, CMS negotiates with the manufacturer of each identified drug. We will refer to these as the Identification Phase and the Negotiation Phase.

During the Identification Phase for any given drug-

pricing period, CMS first identifies “qualifying single source drugs,” which are drugs approved by the FDA for at least seven years and not subject to competition from a generic “that is approved and marketed.” Id. § 1320f-1(e)(1)(A)(i)–(iii). CMS then rank-orders the qualifying single source drugs according to highest associated expenditures under Medicare Part B or Part D over a recent twelve-month period. To determine the total spending on a drug, CMS looks to “data that is aggregated across dosage forms and strengths of the drug, including new formulations of the drug, such as an extended release formulation, and not based on the specific formulation or package size or package type of the drug.” Id. § 1320f- 1(d)(3)(B). The fifty drugs that represent the highest total spending under each respective Part are “negotiation-eligible drugs.” Id. § 1320f-1(d)(1).2

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AstraZeneca Pharmaceuticals LP v. Secretary United States Department of Health and H, 137 F.4th 116 (3d Cir. 2025).

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