Pharmaceutical Research & Manufacturers of America v. Thompson

191 F. Supp. 2d 48, 2002 U.S. Dist. LEXIS 3049, 2002 WL 262037
CourtDistrict Court, District of Columbia
DecidedFebruary 25, 2002
DocketCIV. A. 01-1453(RMU); 8, 10, 17, 18
StatusPublished
Cited by2 cases

This text of 191 F. Supp. 2d 48 (Pharmaceutical Research & Manufacturers of America v. Thompson) 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.

Bluebook
Pharmaceutical Research & Manufacturers of America v. Thompson, 191 F. Supp. 2d 48, 2002 U.S. Dist. LEXIS 3049, 2002 WL 262037 (D.D.C. 2002).

Opinion

MEMORANDUM OPINION

URBINA, District Judge.

Granting the Defendants’ Motion for Summary Judgment; Granting the In-tervenor-Defend ant’s Motion for Summary Judgment; Denying the Plaintiff’s Motion for Summary Judgment

I. INTRODUCTION

This case concerns one state’s use of a manufacturer-rebate scheme to act as a solution for the lack of a prescription drug benefit program for low-income citizens. By bringing the present action, Pharmaceutical Research and Manufacturers of America (“the plaintiff’) challenges the approval of the State of Maine’s Medicaid demonstration project by the Centers for Medicare and Medicaid Services (“CMS”), under the U.S. Department of Health and *51 Human Services (“HHS”). As such, the target defendants in the case are the HHS Secretary and the CMS Administrator (collectively, “the defendants”). The plaintiff alleges violations of Title XIX of the Social Security Act (“the SSA”), as amended 42 U.S.C. § 1396 et seq., and the Administrative Procedure Act, (“the APA”) as amended 5 U.S.C. § 701 et seq. Before the court are the parties’ cross-motions for summary judgment. After consideration of the parties’ submissions and the relevant law, the court grants the defendants’ motion for summary judgment and denies the plaintiffs motion for summary judgment. In addition, the court grants the intervenor-defendant’s motion for summary judgment.

II. BACKGROUND

A. Factual Background

The plaintiff challenges- the State of Maine’s Medicaid demonstration project, known as the Healthy Maine Prescription (“HMP”), which the HHS Secretary approved on January 18, 2001. See Defs.’ Mot. for Summ. J. at 7. Maine put the HMP into effect on June 1, 2001, intending “to do something about the lack of a prescription drug benefit for its low-income citizens” by expanding “Medicaid eligibility for prescription drugs to all individuals with household income up to 300 percent of the Federal Poverty Level.” Administrative Record (“Admin.R;”) at 5. Defendant Tommy G. Thompson, the HHS Secretary, is charged with the responsibility to implement the provisions of Title XIX of the SSA, as amended 42 U.S.C. § 1396 et seq. (the “Medicaid statute”). See Compl. ¶ 13. The HHS Secretary administers the Medicaid program through CMS, a component of HHS. See id. The Secretary is sued in his official capacity only. See id.

The plaintiff challenges the January 18, 2001 decision by the HHS Secretary approving a Medicaid demonstration to be conducted by Maine and allowing Maine to pursue the HMP. See Compl. ¶ 2. The Secretary’s “reason for approving the project was ‘not to restrict Maine’s ability to invest state funds in the health of its citizens,’ but to achieve ‘expanded access to medically necessary drugs’ by making them ‘more affordable to primarily low-income Maine residents who are not eligible for Medicaid.’ ” See Defs.’ Mot. for Summ. J. at 17 (quoting Admin. R. at 28).

The HMP uses a manufacturer-rebate mechanism set forth in 42 U.S.C. § 1396r-8. See Compl. ¶¶ 24-25. Under the HMP, Maine collects rebates from manufacturers quarterly and deposits the rebates into a revolving fund. See Compl. ¶ 26. Providers charge the HMP beneficiaries prices for prescriptions that equal the Medicaid price for a prescription, (i.e., the price that Maine has agreed to pay pharmacies for prescriptions filled under Medicaid) minus a fixed percentage subsidy of 18 percent. See Compl. ¶ 38. Specifically, beneficiaries receive a 14-percent reduction off the available prescription price, calculated by reducing the manufacturers’ rebate of 18 percent by the four percent Maine estimates it would cost on a per-prescription basis to administer the HMP. See Admin. R. at 176-177.

Under the rebate program described in 42 U.S.C. § 1396r-8(a)(1), for a state to receive federal funds to pay for any manufacturer’s drugs, the manufacturer must enter into an agreement with the HHS Secretary to pay a rebate to every state on all of its covered outpatient drugs paid for by Medicaid. See Compl. ¶ 24. The plaintiff contends this program violates the SSA because it costs Maine nothing, but requires drug companies to cover 15 to 18 percent of the cost of covered prescription drugs. See Compl. ¶¶ 39-41, 45-46, 73. The plaintiff claims this feature violates the statutory requirement that a Medicaid *52 plan include some “payment under a state plan” of the cost of “medical assistance.” See 42 U.S.C. §§ 1396r-8, (a); Compl. ¶¶ 4, 44-54. In addition, the plaintiff avers the defendants fail to satisfy the requirement in 42 U.S.C. § 1396o, which provides that states not charge Medicaid beneficiaries more than a “nominal” co-payment. See Compl. ¶¶ 4, 44-54; Mem. of Law in Supp. of Pl.’s Mot. for Summ. J. at 5, 26-28. The plaintiff argues that HMP beneficiaries are paying more than 80 percent of the cost of each prescription they fill. See id. Thus, the plaintiff concludes that such copayments imposed by Maine clearly exceed the “nominal” limit set forth in 42 U.S.C. § 1396o. See id.

To support these arguments, the plaintiff relies on a recent D.C. Circuit decision that addresses a similar program instituted by the State of Vermont. See Pharm. Research and Mfrs. of America v. Thompson (“PhRMA”), 251 F.3d 219 (D.C.Cir.2001); Compl. ¶¶ 1, 5; Mem. of Law in Supp. of Pl.’s Mot. for Summ. J. at 1-5, 8, 13-19, 21, 23-25, 28.

In PhRMA the plaintiff states that the D.C. Circuit struck down a plan “essentially identical” to the Maine HMP, known as the Vermont Pharmacy Discount Program (“PDP”). See Compl. ¶¶1, 5. The D.C. Circuit held that the purchases of drugs under the portion of the project designed to be equal to the anticipated manufacturer rebate could not be deemed purchases for which a “payment” was made by Vermont, as that term is defined under 42 U.S.C. § 1396r-8(b)(1)(A) because “payments are fully reimbursed by manufacturer rebates” and therefore “the rebates produce no savings for the Medicaid program.” See Defs.’ Mot. for Summ. J. at 10 (quoting PhRMA, 251 F.3d at 225).

Shortly after the D.C.

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

Related

Pharm Rsrch Mftr v. Thompson, Tommy G.
321 F.3d 1134 (D.C. Circuit, 2002)

Cite This Page — Counsel Stack

Bluebook (online)
191 F. Supp. 2d 48, 2002 U.S. Dist. LEXIS 3049, 2002 WL 262037, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pharmaceutical-research-manufacturers-of-america-v-thompson-dcd-2002.