Fresenius Kabi USA, LLC v. United States of America

CourtDistrict Court, District of Columbia
DecidedMarch 30, 2026
DocketCivil Action No. 2025-0375
StatusPublished

This text of Fresenius Kabi USA, LLC v. United States of America (Fresenius Kabi USA, LLC v. United States of America) is published on Counsel Stack Legal Research, covering District Court, District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Fresenius Kabi USA, LLC v. United States of America, (D.D.C. 2026).

Opinion

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

FRESENIUS KABI USA, LLC,

Plaintiff,

v. Civil Action No. 25-375 (TJK)

UNITED STATES OF AMERICA, et al.,

Defendants.

MEMORANDUM OPINION

Fresenius Kabi USA, LLC is a manufacturer of injectable drug products that participates

in the Medicaid Drug Rebate Program administered by the Centers for Medicare and Medicaid

Services, or CMS. Through that program, it pays rebates to states based on a drug’s classification

and, in exchange, that drug is eligible for Medicaid coverage. In general, manufacturers pay higher

rebates for “innovator” drugs than for “noninnovator”—or generic—drugs. In 2021, Fresenius

Kabi petitioned CMS to reclassify several of its drugs as noninnovators, so it would pay lower

rebates. In September 2024, CMS denied the request, but informed Fresenius Kabi that it could

respond within a month to supplement or clarify its position, but if it did not, the decision would

be final. Fresenius Kabi timely responded, then followed up by suing CMS, the Department of

Health and Human Services, and relevant officials, alleging that the decision was arbitrary, capri-

cious, and contrary to law under the Administrative Procedure Act. Defendants move to dismiss

under Federal Rule of Civil Procedure 12(b)(6), asserting that CMS’s decision was not final agency

action, so Fresenius Kabi lacks a cause of action. The Court agrees, so it will grant the motion and

dismiss the case. I. Background

A. Statutory and Regulatory Framework

“Medicaid is a cooperative federal-state program that provides federal funding for state

medical services to the poor.” Frew ex rel. Frew v. Hawkins, 540 U.S. 431, 433 (2004). Congress

created the Medicaid Drug Rebate Program “to offset Medicaid costs incurred by the federal gov-

ernment and the states for outpatient drugs provided to Medicaid recipients.” Council on Radio-

nuclides & Radiopharmaceuticals, Inc. v. Azar, 18-cv-633 (RBW), 2019 WL 5960142, at *2

(D.D.C. Nov. 13, 2019). For a drug to be eligible for Medicaid reimbursement, the manufacturer

must enter into a rebate agreement with the Department of Health and Human Services to pay

rebates to states. 42 U.S.C. §§ 1396r-8(a)(1), (c)(1)(A), (c)(3)(A). The rebate rate for a drug

depends on its classification as either: (1) “single source” (2) “innovator multiple source” or (3)

“noninnovator multiple source”—a generic drug. See id. §§ 1396r-8(c)(1), (3); id. § 1396r-

8(k)(7)(A). Rebate rates for noninnovator drugs are lower than those for single source and inno-

vator drugs. See id. § 1396r-8(c). In 2016, CMS established a “narrow exception” process through

which, under certain circumstances, drug manufacturers could apply to have an innovator drug

treated as a noninnovator for purposes of calculating rebate liability. See ECF No. 1 ¶ 69; see also

42 C.F.R. § 447.502. The process was intended “to ensure that drugs that are or were required to

be marketed under an original new drug application for technical reasons would not be erroneously

classified as innovators.” ECF No. 1 ¶ 69 (citation omitted).

B. Procedural Background

Fresenius Kabi is a global health care company and drug manufacturer. ECF No. 1 ¶ 9.

One of the drugs it manufactures is heparin, a common anticoagulant. Id. ¶¶ 1–2, 75. Fresenius

Kabi’s heparin products come in many forms, including vials, prefilled syringes, and—relevant

2 here—pre-mixed intravenous bags. Id. ¶ 2. In June 2021, Fresenius Kabi requested a narrow

exception for several heparin products—including four types of premixed heparin bags and one

type of prefilled heparin syringe. Id. ¶ 96. Between February and March 2024, CMS granted

narrow exceptions for some of these products, including heparin vials and prefilled syringes. Id.

¶¶ 100–101.

On September 30, 2024, though, CMS sent Fresenius Kabi a letter denying the company’s

request for a narrow exception for four of its heparin bag products. See generally ECF No. 1-8.

The letter informed Fresenius Kabi that CMS had “decline[d] to . . . grant a narrow exception and

den[ied] [its] request to report the drugs . . . as noninnovator multiple source . . . drugs.” Id. at 2.

CMS further advised Fresenius Kabi that “[i]f [it] ha[d] any questions or concerns” about the letter,

it should “respond within 30 days . . . with any supplements to or clarifications of [its] positions in

[its] request” and to “include detailed supporting documentation if available.” Id. at 5. Moreover,

the letter provided that “[i]f [CMS] does not receive any written response by 30 days, then the

decision in this letter is final.” Id.

On October 29, 2024, Fresenius Kabi responded with its own letter, challenging CMS’s

decision as both outside its legal authority and in violation of “CMS guidance and precedent.”

ECF No. 19-5 at 3. The letter also advised that, unless the agency rescinded the decision by De-

cember 2, 2024, Fresenius Kabi intended “to amend its complaint in . . . pending litigation . . . to

establish that all of the heparin products marketed by Fresenius Kabi are . . . noninnovator drugs

. . . entitled to narrow exceptions.” Id. (emphasis in original).1 Fresenius Kabi included with its

1 In March 2024, Fresenius Kabi filed a separate lawsuit seeking to clarify the effective date of narrow exceptions granted for drugs not at issue here. See Fresenius Kabi USA, LLC v. United States, 24-cv-676 (TJK) (D.D.C. Oct. 11, 2024) (“Fresenius Kabi I”).

3 letter a 30-page white paper “setting forth more fully [its] intended legal challenge.” See id. at 5.2

CMS has not yet responded. See ECF No. 25 at 11.

Rather than amend its pending complaint, however, Fresenius Kabi filed this lawsuit on

February 7, 2025, against the United States, the Department of Health and Human Services, the

Centers for Medicare and Medicaid Services, and officials in charge of these agencies. It alleges

that CMS’s decision declining to classify the four heparin bag products as noninnovators was ar-

bitrary, capricious, and contrary to law under the Administrative Procedure Act (“APA”). See

ECF No. 1 at 31–37. Defendants move to dismiss, arguing that CMS’s decision was not final

agency action reviewable under the APA, so Fresenius Kabi lacks a cause of action. ECF No. 19.3

II. Legal Standard

To survive a motion under Rule 12(b)(6), a plaintiff must have pleaded “enough facts to

state a claim to relief that is plausible on its face and to nudge [its] claims across the line from

conceivable to plausible.” Abbas v. Foreign Pol’y Grp., 783 F.3d 1328, 1338 (D.C. Cir. 2015)

(internal quotations omitted). To meet this standard, a plaintiff must plead “factual content that

allows the court to draw the reasonable inference that the defendant[s] [are] liable for the

2 The Court may consider Fresenius Kabi’s response letter and white paper, attached as an exhibit to Defendants’ motion to dismiss, see ECF No.

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