Indiana Pharmacists Ass'n v. Indiana Family & Social Services Administration

881 F. Supp. 395, 1994 U.S. Dist. LEXIS 20073, 1994 WL 779294
CourtDistrict Court, S.D. Indiana
DecidedDecember 13, 1994
DocketNo. IP 94-328 C
StatusPublished
Cited by2 cases

This text of 881 F. Supp. 395 (Indiana Pharmacists Ass'n v. Indiana Family & Social Services Administration) is published on Counsel Stack Legal Research, covering District Court, S.D. Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Indiana Pharmacists Ass'n v. Indiana Family & Social Services Administration, 881 F. Supp. 395, 1994 U.S. Dist. LEXIS 20073, 1994 WL 779294 (S.D. Ind. 1994).

Opinion

MEMORANDUM ENTRY

BARKER, Chief Judge.

This matter is before the Court on Plaintiffs’ motion for summary judgment. For the reasons stated below, Plaintiffs’ motion is granted insofar as it requests injunctive and declaratory relief. However, the issues of class certification and damages remain to be decided and require further briefing.

I. BACKGROUND

In this case the Court is asked to decide whether Indiana’s Medicaid regulations gov-[397]*397eming recipient copayments for pharmacy services violate federal law. The Plaintiffs, the Indiana Pharmacists’ Association and two for-profit pharmacies, claim that Ind.Code § 12-15-6 and 405 Ind. Admin. Code § 1-6-21.1 conflict with 42 U.S.C. § 1396r-8(e)(l) (the “Moratorium”), which places a moratorium on reductions in payment limits or dispensing fees for pharmacies that provide outpatient drugs to Medicaid recipients. Indiana’s code provisions require a copayment from the Medicaid recipient of fifty cents for each multiple source (generic) drug dispensed and one dollar for each single source (brand name) drug dispensed. Federal law prohibits providers from refusing to furnish Medicaid services if a Medicaid recipient is unable to pay the copayment. See 42 C.F.R. § 447.15. Indiana’s regulations make no provision, however, for providers to seek reimbursement from the State for recipients who do not make a copayment. The Plaintiffs claim that the copayment program contravenes the Moratorium by reducing the amount paid to a pharmacy without regard to the ability of the pharmacy to collect the copayment.

The Defendants (collectively the “State”) assert that federal law explicitly allows the imposition of copayments and that the state rules do not conflict with the Moratorium. The State claims that the Moratorium merely prohibits reduction of payment limits with respect to the ingredient cost of covered outpatient drugs and reductions in dispensing fees for these drugs. The State further claims that Indiana’s copayment plan does not reduce the payment limits or amounts which pharmacists are entitled to receive, but merely changes the composition of and relative liability for the actual payments.

Plaintiffs seek damages for the copay-ments they have not received under the Indiana program, attorneys’ fees, and an injunction against the State law.insofar as it does not comport with the federal Moratorium. Plaintiffs’ Complaint contains class action allegations and seeks damages on behalf of the entire class of “Indiana pharmacies and pharmacists [who participate] in the Medicaid program” and who have supplied Medicaid beneficiaries with qualifying prescriptions but have not been wholly reimbursed by the copayment system; however, Plaintiffs have not filed a motion to certify the class and the issue of class certification has not yet been decided. See Fed.R.Civ.P. 23(c); S.D.Ind. LR 23.1.

II. DISCUSSION

Under Rule 56(c) of the Federal Rules of Civil Procedure, summary judgment is proper “if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.” Fed.R.Civ.Proc. 56(c). While the burden rests squarely on the party moving for summary judgment to show “that there is an absence of evidence to support the nonmoving party’s case”, Celotex Corp. v. Catrett, 477 U.S. 317, 325, 106 S.Ct. 2548, 2554, 91 L.Ed.2d 265 (1986), the nonmoving party responding to a properly made and supported summary judgment motion still must set forth facts showing that there is a genuine issue of material fact and that a reasonable jury could return a verdict in its favor. See Wolf v. City of Fitchburg, 870 F.2d 1327, 1329 (7th Cir.1989); Posey v. Skyline Corp., 702 F.2d 102, 105 (7th Cir.1983), cert. denied, 464 U.S. 960, 104 S.Ct. 392, 78 L.Ed.2d 336 (1983). If doubts remain, however, as to the existence of a material fact; then those doubts should be resolved in favor of the nonmoving party and summary judgment denied. See Wolf, 870 F.2d at 1330.

The first determination that must be made is whether the Moratorium clearly forbids the establishment of Indiana’s copayment program; “[i]f the intent of Congress is clear, that is the end of the matter; for the court, as well as the agency, must give effect to the unambiguously expressed intent of Congress.” Chevron, U.S.A, Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 842-43, 104 S.Ct. 2778, 2781, 81 L.Ed.2d 694 (1984). If the statute does not answer the “precise question at issue” the court then looks to the agency charged with administering the statute for guidance:

[398]*398If, however, the court determines congress has not directly addressed the precise question at issue, the court does not simply impose its own construction of the statute, as would be necessary in the absence of an administrative interpretation. Rather, if the statute is silent or ambiguous with respect to the specific issue, the question for the court is whether the agency’s answer is based on a permissible construction of the statute.

Id. at 843-44, 104 S.Ct. at 2782. In order for the court to find the agency’s construction of the statute to be permissible, it must not be arbitrary, capricious, or manifestly contrary to the statute. Id. However, the construction may be permissible even if it is not one that the court would have reached'on its own: “[t]he court need not conclude that the agency construction was the only one it permissibly could have adopted to uphold the construction, or even the reading the court would have reached if the question initially had arisen in a judicial proceeding.” Id. (citations omitted).1

■ The standard for finding that a statute is clear is a high one: Congress must have “directly addressed the precise question at issue.” Chevron, 467 U.S. at 843, 104 S.Ct. at 2782. In the instant case, the precise question is whether a state is permitted, under the terms of the Moratorium, to transfer part of the reimbursement burden to Medicaid beneficiaries, even where the beneficiaries do not ever actually make the required copayments to the pharmacies. The Moratorium provides, in pertinent part:

(e) Treatment of Pharmacy Reimbursement Limits
(1) In general

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881 F. Supp. 395, 1994 U.S. Dist. LEXIS 20073, 1994 WL 779294, Counsel Stack Legal Research, https://law.counselstack.com/opinion/indiana-pharmacists-assn-v-indiana-family-social-services-insd-1994.