Madison v. Mississippi Medicaid Commission

86 F.R.D. 178
CourtDistrict Court, N.D. Mississippi
DecidedMarch 21, 1980
DocketNo. GC 79-154-OS-P
StatusPublished
Cited by9 cases

This text of 86 F.R.D. 178 (Madison v. Mississippi Medicaid Commission) is published on Counsel Stack Legal Research, covering District Court, N.D. Mississippi primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Madison v. Mississippi Medicaid Commission, 86 F.R.D. 178 (N.D. Miss. 1980).

Opinion

MEMORANDUM OF DECISION

ORMA R. SMITH, District Judge.

This action is before the court upon the defendants’ motion to dismiss or in the alternative for summary judgment, the plaintiffs’ motion for class certification, and three applications by the defendants for review of the magistrate’s orders relating to discovery issues. The eleven named plaintiffs are all adult resident citizens of Mississippi who are licensed to practice pharmacy in the State, and who are the owners, in whole or in part, of pharmacies or drugstores doing business in Mississippi. They seek to represent a class composed of all pharmacists licensed in Mississippi and practicing pharmacy in the State who

have been or are sole proprietors or general partners in retail pharmacy businesses in Mississippi or have been or are majority stockholders in corporations organized for doing business as a retail pharmacy in Mississippi and which pharmacy has been or is now a traditional, community, independently owned and operated pharmacy and who have been or are dispensing medical prescriptions for Medicaid patients under the Medical Assistance program.

In their motion for class certification, the plaintiffs allege that there are approximately 700 members of this class. The defendants in this action are the Mississippi Medicaid Commission, its seven members, and its Director and Deputy Director. All of the individual defendants are made parties in their official capacities, and are alleged to have acted under color of state law.

The actions forming the basis for the plaintiffs’ complaint arise out of the defendants’ implementation of Title XIX of the Social Security Act of 1935, the Medical Assistance Program (hereinafter referred to as “Medicaid”). 42 U.S.C. § 1396, et seq. Under § 1396, the federal government authorizes and appropriates sums of money “for making payments to States which have submitted, and have approved by the Secretary of Health, Education, and Welfare, State plans for medical assistance.” The requirements which these plans must meet are set forth at 42 U.S.C. § 1396a. In general, these State plans must provide certain standards and methods by which individuals are to receive Medicaid payments and other forms of assistance, and also the methods by which individuals eligible for Medicaid may obtain assistance from participating doctors and pharmacies. The federal government shares with the States the cost of reimbursing participating agencies, doctors, and pharmacies for services rendered to eligible recipients. 42 U.S.C. §§ 1396a, 1396d. To insure that the purpose of the Act is carried out, the Secretary of Health, Education, and Welfare is authorized to promulgate rules and regulations relating to all aspects of the Medicaid program. 42 U.S.C. § 1302. The regulations prescribing the procedures for payments by State Medicaid agencies for Medicaid services are set out at 42 C.F.R. § 447.

On the state level, the Mississippi Medicaid law was enacted in 1969, and provides for a statewide system of medical assistance, to be administered by the Mississippi Medicaid Commission. Miss.Code Ann. § 43-13-101, et seq. (1972 & Supp.1979). In administering this program, the Commission is “authorized and empowered” to adopt rules and regulations

Establishing reasonable fees, charges and rates for medical services and drugs; and [181]*181in doing so [the Commission] shall fix all such fees, charges and rates at the minimum levels absolutely necessary to provide the medical assistance authorized by this article; .

Miss.Code Ann. § 43-13-121 (Supp.1979).

The conduct about which the plaintiffs complain arises out of an alleged conflict between the language of certain federal regulations, and the language of the state statute and supporting regulations, as they relate to reimbursement to pharmacists for drugs dispensed to eligible Medicaid recipients. The applicable state statute provides, in pertinent part, that

The commission shall provide by regulations that reimbursement for drugs shall be limited to the actual acquisition cost, plus the reasonable cost of handling, as determined by the commission.

Miss.Code Ann. § 43-13-117(9) (Supp.1979). Pursuant to this authority, the Mississippi Medicaid Commission has promulgated a regulation which provides that reimbursement to pharmacists will be based upon the lower of: (1) actual acquisition cost, which is the net invoice cost including quantity discounts but excluding cash discounts not exceeding 2%; (2) maximum allowable cost, which is that cost determined by the Pharmaceutical Reimbursement Board of the Department of Health, Education, and Welfare; or (3) the usual and customary retail charge for identical prescriptions.1 This regulation was later amended to eliminate the allowance for cash discounts and to provide that the dispensing fee would be $2.50 per prescription.

The plaintiffs contend that the state’s definition of “acquisition cost” in terms of “net invoice cost”, is in conflict with applicable federal regulations. They contend that the federal regulations which are controlling in this situation define “acquisition cost” as

the price generally and currently paid by providers for a drug marketed or sold by a particular formulator or labeler in the package size of drug most frequently purchased by providers.

See, 42 C.F.R. § 50.502(e) and 45 C.F.R. § 19.2(f). According to the plaintiffs, these two methods of defining the term “acquisition cost” are in direct conflict, and the defendants’ definition results in lower reimbursements to the plaintiffs than would be the result if the federal definition was followed. They allege, therefore, that the defendants have violated 42 U.S.C. § 1983 by acting under color of state law to deprive them of property without due process of law. Plaintiffs further contend that, by not taking into account their “business efficiency practices” in earning discounts from wholesalers, the defendants reimburse other pharmacists at higher amounts than the plaintiffs are reimbursed. This practice, they contend, creates a classification which denies the plaintiffs equal protection of the laws.

I. DEFENDANTS’MOTION TO DISMISS

The defendants have now filed a motion to dismiss, or in the alternative for summary judgment, with respect to the plaintiffs’ claims regarding cost reimbursement for drugs.

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Cite This Page — Counsel Stack

Bluebook (online)
86 F.R.D. 178, Counsel Stack Legal Research, https://law.counselstack.com/opinion/madison-v-mississippi-medicaid-commission-msnd-1980.