Beeman v. ANTHEM PRESCRIPTION MANAGEMENT, LLC

661 F.3d 1199
CourtCourt of Appeals for the Ninth Circuit
DecidedJuly 19, 2011
Docket07-56692
StatusPublished

This text of 661 F.3d 1199 (Beeman v. ANTHEM PRESCRIPTION MANAGEMENT, LLC) is published on Counsel Stack Legal Research, covering Court of Appeals for the Ninth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Beeman v. ANTHEM PRESCRIPTION MANAGEMENT, LLC, 661 F.3d 1199 (9th Cir. 2011).

Opinion

652 F.3d 1085 (2011)

JERRY BEEMAN AND PHARMACY SERVICES, INC., doing business as Beemans Pharmacy; Anthony Hutchinson and Rocida Inc., doing business as Finleys Rexall Drug; Charles Miller, doing business as Yucaipai Valley Pharmacy; Jim Morisoli and American Surgical Pharmacy Inc., doing business as American Surgical Pharmacy; Bill Pearson and Pearson and House, on behalf of themselves and all others similarly situated and on behalf of the general public; doing business as Pearson Medical Group Pharmacy, Plaintiffs-Appellees,
v.
ANTHEM PRESCRIPTION MANAGEMENT, LLC; Argus Health Systems, Inc.; Benescript Services, Inc.; FFI Rx Managed Care; First Health Services Corporation; Managed Pharmacy Benefits, Inc., formerly known as Cardinal Health MPB Inc.; National Medical Health Card Systems, Inc.; Pharmacare Management Services, Inc.; Prime Therapeutics; Restat Corporation; Rx Solutions, Inc.; Tmesys, Inc.; WHP Health Initiatives, Inc.; Mede America Corp., Defendants-Appellants.
Jerry Beeman and Pharmacy Services, Inc., doing business as Beemans Pharmacy; Anthony Hutchinson and Rocida Inc., doing business as Finleys Rexall Drug; Charles Miller, doing business as Yucaipai Valley Pharmacy; Jim Morisoli and American Surgical Pharmacy Inc, doing business as American Surgical Pharmacy; Bill Pearson and Pearson and House, on behalf of themselves and all others similarly situated and on behalf of the general public; doing business as Pearson Medical Group Pharmacy, Plaintiffs-Appellees,
v.
TDI Managed Care Services, Inc., doing business as Eckerd Health Services; Medco Health Solutions, Inc.; Express Scripts, Inc.; Advance PCS, Advance PCS Health, L.P.; Rx Solutions, Inc., Defendants-Appellants.

Nos. 07-56692, 07-56693.

United States Court of Appeals, Ninth Circuit.

Argued and Submitted March 8, 2011.
Filed July 19, 2011.

*1089 Thomas M. Peterson (argued), Morgan Lewis & Bockius, LLP, San Francisco, CA, for the defendants-appellants.

Michael A. Bowse (argued), Brovrae Woods George LLP, Los Angeles, CA, for the plaintiffs-appellees.

Before: BETTY B. FLETCHER, STEPHEN REINHARDT, and KIM McLANE WARDLAW, Circuit Judges.

Opinion by Judge B. FLETCHER; Dissent by Judge WARDLAW.

OPINION

B. FLETCHER, Circuit Judge:

In this consolidated appeal, defendants-appellants (collectively "Defendants") appeal the denial by the district court of their motions for judgment on the pleadings. Plaintiffs-appellees (collectively "Plaintiffs") brought this diversity suit against Defendants to enforce California Civil Code §§ 2527 and 2528. These statutes require Defendants to supply the results of bi-annual studies of California pharmacies' retail drug pricing for private uninsured customers to theu" chents, who are third-party payors such as insurance companies and self-insured employer groups. In their motions for judgment, Defendants argued that California Civil Code § 2527 (herein-after "§ 2527") compels speech in violation of the United States and California Constitutions. The district court denied the motions, first reasoning that it was not bound by the state appellate court decisions striking down the statute under the California Constitution, and then holding that § 2527 does not unconstitutionally compel speech. Defendants obtained permission to file an interlocutory appeal. We accordingly have jurisdiction under 28 U.S.C. § 1292(b).

In this appeal, we must decide (1) whether we are bound by the Erie doctrine to follow the state appellate court decisions striking down § 2527, and, if not, (2) whether § 2527 violates the First Amendment or the California Constitution's free speech provision. We conclude that Erie does not require us to follow the state appellate court decisions, and that *1090 § 2527 does not unconstitutionally compel speech under either the United States or California Constitution. We therefore affirm.

I.

A. Factual Background

Plaintiffs own five independent retail pharmacies licensed in California. Defendants are current or former pharmacy benefit managers ("PBMs"). They "contract with third-party payors or health plan administrators such as insurers, HMOs, governmental entities, and employer groups to facilitate cost-effective delivery of prescription drugs to health plan members or other persons to whom the third-party payors provide prescription drug benefits." PBMs assist in the "processing of prepaid or insured prescription drug benefit claims submitted by a licensed California pharmacy or patron thereof." In other words, PBMs act as intermediaries between pharmacies and third-party payors such as health insurance companies. Pursuant to this role, PBMs may create networks of retail pharmacies that agree to accept certain reimbursement rates when they fill prescriptions for health plan members. According to Defendants, network reimbursements "generally are lower than what pharmacies would charge uninsured, cash-paying customers."

Section 2527, the challenged statute, requires "prescription drug claims processors"[1] to conduct or obtain studies every 24 months identifying the fees California pharmacies charge to private customers for pharmaceutical dispensing services. Cal. Civ.Code § 2527(c).[2] The claims processors must send the results of these studies to "each client for whom [they] perform[] claims processing services," or, in other words, to third party payors such as insurers. Id. § 2527(d).[3] Section 2528 imposes civil penalties ranging from $1,000 to $10,000 for violations of § 2527. Cal. Civ.Code § 2528.

The legislative history of § 2527 reveals that the original bill, introduced by the *1091 California Pharmacists Association in 1981, required pharmacies to be reimbursed according to their "customary charges" rather than according to rates "unilaterally set by PBMs." Beeman v. TDI Managed Care Services, Inc., 449 F.3d 1035, 1038 (9th Cir.2006) ("TDI Managed Care"). The bill was then amended in committee to substitute the reimbursement requirements with the current PBM reporting requirements. According to legislative staff comments, the "purpose of this [amended] bill is to require claims processors to present objective data on the range and percentiles of usual and customary charges of pharmacists in the hope that at a time in the future this information will become the basis for reimbursement." In recommending that the Governor sign the bill, California's Department of Insurance advised that § 2527 "is fairly innocuous in its impact, since it merely requires a study to be made and distributed to clients, and does not require any action to be taken on the basis of that study." The Department further noted that the statute could "help identify areas for cost-containment in the future."

B. Procedural Background

In 2002, Plaintiffs filed a class action complaint in the Central District of California (Beeman 02) alleging, inter alia, that Defendants failed to conduct the fee studies mandated by § 2527(c). In 2004, Plaintiffs filed a second complaint (Beeman 04) alleging the same violation against a second group of Defendants. Both cases were assigned to Judge Virginia Phillips, but have not been consolidated.

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

Related

Milavetz, Gallop & Milavetz, P. A. v. United States
559 U.S. 229 (Supreme Court, 2010)
Swift v. Tyson
41 U.S. 1 (Supreme Court, 1842)
Erie Railroad v. Tompkins
304 U.S. 64 (Supreme Court, 1938)
West v. American Telephone & Telegraph Co.
311 U.S. 223 (Supreme Court, 1940)
Stoner v. New York Life Insurance
311 U.S. 464 (Supreme Court, 1941)
West Virginia State Board of Education v. Barnette
319 U.S. 624 (Supreme Court, 1943)
Kovacs v. Cooper
336 U.S. 77 (Supreme Court, 1949)
Joseph Burstyn, Inc. v. Wilson
343 U.S. 495 (Supreme Court, 1952)
Miami Herald Publishing Co. v. Tornillo
418 U.S. 241 (Supreme Court, 1974)
Wooley v. Maynard
430 U.S. 705 (Supreme Court, 1977)
Abood v. Detroit Board of Education
431 U.S. 209 (Supreme Court, 1977)
PruneYard Shopping Center v. Robins
447 U.S. 74 (Supreme Court, 1980)
Metromedia, Inc. v. City of San Diego
453 U.S. 490 (Supreme Court, 1981)
Philadelphia Newspapers, Inc. v. Hepps
475 U.S. 767 (Supreme Court, 1986)

Cite This Page — Counsel Stack

Bluebook (online)
661 F.3d 1199, Counsel Stack Legal Research, https://law.counselstack.com/opinion/beeman-v-anthem-prescription-management-llc-ca9-2011.