Premier, Inc. v. Health Resources and Services Administration

CourtDistrict Court, District of Columbia
DecidedMarch 31, 2026
DocketCivil Action No. 2024-3116
StatusPublished

This text of Premier, Inc. v. Health Resources and Services Administration (Premier, Inc. v. Health Resources and Services Administration) 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
Premier, Inc. v. Health Resources and Services Administration, (D.D.C. 2026).

Opinion

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

PREMIER, INC.,

Plaintiff,

v. Civil Action No. 24 - 3116 (LLA) HEALTH RESOURCES AND SERVICES ADMINISTRATION, et al.,

Defendants.

MEMORANDUM OPINION

Congress has determined that certain healthcare providers are eligible to purchase

prescription drugs at discounted prices, which manufacturers must offer as a condition for

participation in the Medicaid program. For qualifying hospitals to access the lower prices, they

may not obtain covered prescription drugs through a group purchasing organization (“GPO”) or

an agreement that negotiates lower prices through members’ collective bargaining power. This

case concerns a 2013 policy issued by the Health Resources and Services Administration

(“HRSA”) about how hospitals subject to that group purchasing prohibition procure and pay for

covered drugs (“2013 Policy”).

Plaintiff Premier, Inc., brings this action against HRSA, HRSA Administrator Thomas J.

Engels, the U.S. Department of Health and Human Services (“HHS”), and HHS Secretary Robert

F. Kennedy, Jr.,1 alleging that the 2013 Policy is an impermissible legislative rule that is contrary

1 Premier named former HRSA Administrator Carole Johnson and former HHS Secretary Xavier Becerra as Defendants, but the current officials are “automatically substituted” as parties pursuant to Federal Rule of Civil Procedure 25(d). to the statute and arbitrary and capricious in violation of the Administrative Procedure Act

(“APA”), 5 U.S.C. § 551 et seq. ECF No. 1. Premier asks the court to declare the 2013 Policy

unlawful and set it aside. Id. at 33-34. Both parties have moved for summary judgment. ECF

Nos. 11, 15. For the reasons discussed below, the court concludes that the 2013 Policy is arbitrary

and capricious and must be vacated. Accordingly, the court will grant Premier’s motion in part

and deny Defendants’ motion.

I. STATUTORY BACKGROUND AND REGULATORY HISTORY

A. Section 340B Program

“Section 340B of the Public Health Services Act . . . imposes ceilings on prices drug

manufacturers may charge for medications sold to specified health-care facilities.” Astra USA,

Inc. v. Santa Clara County, 563 U.S. 110, 113 (2011). “The ceiling price is fixed by a statutory

formula strikingly generous to purchasers.” Novartis Pharms. Corp. v. Johnson, 102 F.4th 452,

456 (D.C. Cir. 2024). HRSA, a unit within HHS, administers the program, Astra USA, 563 U.S.

at 113, which Congress established in the Veterans Health Care Act of 1992, Pub. L. No. 102-585,

§ 602, 106 Stat. 4943, 4967-71.2 To incentivize companies to provide discounts, the law

conditions a drug manufacturer’s “eligibility for Medicaid matching funds” and Medicare Part B

payments on the manufacturer’s participation in the Section 340B Program. Cares Cmty. Health

v. U.S. Dep’t of Health & Hum. Servs., 944 F.3d 950, 955 (D.C. Cir. 2019) (quoting Univ. Med.

Ctr. of S. Nev. v. Shalala, 173 F.3d 438, 439 (D.C. Cir. 1999)); 42 U.S.C. § 1396r-8(a)(1), (a)(5).

2 The Veterans Health Care Act of 1992 amended the Public Health Service Act, Pub. L. No. 78-410, ch. 373, 58 Stat. 682 (1944). See § 602(a), 106 Stat. at 4967.

2 Participating manufacturers enter into agreements with HRSA to charge “covered entities”

less than “predetermined ceiling prices” derived from the “‘average’ [manufacturer] . . . prices and

rebates calculated under the Medicaid Drug Rebate Program.” Astra USA, 563 U.S. at 115

(quoting 42 U.S.C. § 256b(a)(1)). The Medicaid Drug Rebate Program, enacted in 1990, “covers

a significant portion of drug purchases in the United States” and served as a template for the

Section 340B Program. Id. at 114.

To qualify as a “covered entity,” a facility must “fit within [the] narrow categories” of

“healthcare providers” set forth in 42 U.S.C. § 256b(a)(4), which Congress expanded in the

Affordable Care Act in 2010. Novartis Pharms., 102 F.4th at 455-56; see Pub. L. No. 111-148,

§§ 7101-02, 124 Stat. 119, 821-27. Only one type of covered entity is implicated here: hospitals

(1) that are run by a state or local government or certain public or private non-profits or that

“provide health care services to low income individuals” who are not Medicare beneficiaries;

(2) that have a “disproportionate share adjustment percentage” above the statutory threshold;3 and

(3) that “do[] not obtain covered outpatient drugs through a group purchasing organization or other

group purchasing arrangement.” 42 U.S.C. § 256b(a)(4)(L). The court refers to these covered

entities as disproportionate share hospitals (“DSHs”). See, e.g., Pharm. Rsch. & Mfrs. of Am. v.

U.S. Dep’t of Health & Hum. Servs., 43 F. Supp. 3d 28, 31 (D.D.C. 2014).

The parties’ dispute concerns the third eligibility requirement, known as the

“GPO prohibition,” which bars DSHs from obtaining “covered outpatient drugs through a group

3 The “disproportionate share adjustment percentage” is a complex formula used to identify “hospitals serving an ‘unusually high percentage of low-income patients’” that are entitled to “enhanced Medicare payments” for services provided to certain Medicare beneficiaries. Becerra v. Empire Health Found., for Valley Hosp. Med. Ctr., 597 U.S. 424, 429 (2022) (quoting Sebelius v. Auburn Reg’l Med. Ctr., 568 U.S. 145, 150 (2013)).

3 purchasing organization or other group purchasing arrangement.” 42 U.S.C. § 256b(a)(4)(L)(iii).

A “covered outpatient drug” for Section 340B purposes is any drug that meets the definition of

that term in Section 1927(k) of the Social Security Act, with several exceptions not at issue here.

Id. § 256b(b)(1), (b)(2).

In addition to meeting the statutory criteria for the Section 340B Program, covered entities

must comply with program requirements set forth in 42 U.S.C. § 256b(a)(5). “[T]he statute

prohibits ‘diversion,’ which occurs when covered entities ‘resell or otherwise transfer the drug to

a person who is not a patient of the entity.’” Novartis Pharms., 102 F.4th at 456 (quoting 42 U.S.C.

§ 256b(a)(5)(B)). It also “prohibits covered entities from receiving the [S]ection 340B discount

on drugs also subject to a Medicaid rebate.” Id.; see 42 U.S.C. § 256b(a)(5)(A)(i). And a covered

entity “shall permit the [HHS] Secretary and the manufacturer of a covered outpatient drug” to

“audit at the Secretary’s or the manufacturer’s expense” any of the entity’s “records . . . that

directly pertain” to its “compliance” with the prohibitions on diversion and duplicating discounts.

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