Rutledge v. Pharmaceutical Care Management Assn.

592 U.S. 80, 208 L. Ed. 2d 327, 141 S. Ct. 474
CourtSupreme Court of the United States
DecidedDecember 10, 2020
Docket18-540
StatusPublished
Cited by66 cases

This text of 592 U.S. 80 (Rutledge v. Pharmaceutical Care Management Assn.) is published on Counsel Stack Legal Research, covering Supreme Court of the United States primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rutledge v. Pharmaceutical Care Management Assn., 592 U.S. 80, 208 L. Ed. 2d 327, 141 S. Ct. 474 (2020).

Opinion

(Slip Opinion) OCTOBER TERM, 2020 1

Syllabus

NOTE: Where it is feasible, a syllabus (headnote) will be released, as is being done in connection with this case, at the time the opinion is issued. The syllabus constitutes no part of the opinion of the Court but has been prepared by the Reporter of Decisions for the convenience of the reader. See United States v. Detroit Timber & Lumber Co., 200 U. S. 321, 337.

SUPREME COURT OF THE UNITED STATES

RUTLEDGE, ATTORNEY GENERAL OF ARKANSAS v. PHARMACEUTICAL CARE MANAGEMENT ASSOCIATION

CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE EIGHTH CIRCUIT

No. 18–540. Argued October 6, 2020—Decided December 10, 2020 Pharmacy benefit managers (PBMs) act as intermediaries between phar- macies and prescription-drug plans. In that role, they reimburse phar- macies for the cost of drugs covered by prescription-drug plans. To determine the reimbursement rate for each drug, PBMs develop and administer maximum allowable cost (MAC) lists. In 2015, Arkansas passed Act 900, which effectively requires PBMs to reimburse Arkan- sas pharmacies at a price equal to or higher than the pharmacy’s wholesale cost. To accomplish this result, Act 900 requires PBMs to timely update their MAC lists when drug wholesale prices increase, Ark. Code Ann. §17–92–507(c)(2), and to provide pharmacies an ad- ministrative appeal procedure to challenge MAC reimbursement rates, §17–92–507(c)(4)(A)(i)(b). Act 900 also permits Arkansas pharmacies to refuse to sell a drug if the reimbursement rate is lower than its ac- quisition cost. §17–92–507(e). Respondent Pharmaceutical Care Man- agement Association (PCMA), which represents the 11 largest PBMs in the country, sued, alleging, as relevant here, that Act 900 is pre- empted by the Employee Retirement Income Security Act of 1974 (ERISA). Following Circuit precedent in a case involving a similar Iowa statute, the District Court held that ERISA pre-empts Act 900. The Eighth Circuit affirmed. Held: Arkansas’ Act 900 is not pre-empted by ERISA. Pp. 4–10. (a) ERISA pre-empts state laws that “relate to” a covered employee benefit plan. 29 U. S. C. §1144(a). “[A] state law relates to an ERISA plan if it has a connection with or reference to such a plan.” Egelhoff 2 RUTLEDGE v. PHARMACEUTICAL CARE MANAGEMENT ASSN. Syllabus

v. Egelhoff, 532 U. S. 141, 147. Act 900 has neither of those impermis- sible relationships. Pp. 4–7. (1) Act 900 does not have an impermissible connection with an ERISA plan. To determine whether such a connection exists, this Court asks whether the state law “governs a central matter of plan administration or interferes with nationally uniform plan administra- tion.” Gobeille v. Liberty Mut. Ins. Co., 577 U. S. 312, 320. State rate regulations that merely increase costs or alter incentives for ERISA plans without forcing plans to adopt any particular scheme of substan- tive coverage are not pre-empted by ERISA. See New York State Con- ference of Blue Cross & Blue Shield Plans v. Travelers Ins. Co., 514 U. S. 645, 668. Like the law at issue in Travelers, Act 900 is merely a form of cost regulation that does not dictate plan choices. Pp. 4–6. (2) Act 900 also does not “refer to” ERISA. It does not “ ‘ac[t] im- mediately and exclusively upon ERISA plans,’ ” and “ ‘the existence of ERISA plans is [not] essential to the law’s operation.’ ” Gobeille, 577 U. S., at 319–320. Act 900 affects plans only insofar as PBMs may pass along higher pharmacy rates to plans with which they contract, and Act 900 regulates PBMs whether or not the plans they service fall within ERISA’s coverage. ERISA plans are therefore also not essential to Act 900’s operation. Pp. 6–7. (b) PCMA’s contention that Act 900 has an impermissible connection with an ERISA plan because its enforcement mechanisms both directly affect central matters of plan administration and interfere with na- tionally uniform plan administration is unconvincing. First, its claim that Act 900 affects plan design by mandating a particular pricing methodology for pharmacy benefits is simply a long way of saying that Act 900 regulates reimbursement rates. Second, Act 900’s appeal pro- cedure does not govern central matters of plan administration simply because it requires administrators to comply with a particular process and may require a plan to reprocess how much it owes a PBM. Taken to its logical endpoint, PCMA’s argument would pre-empt any suits under state law that could affect the price or provision of benefits, but this Court has held that ERISA does not pre-empt “state-law mecha- nisms of executing judgments against” ERISA plans, Mackey v. Lanier Collection Agency & Service, Inc., 486 U. S. 825, 831. Third, allowing pharmacies to decline to dispense a prescription if the PBM’s reim- bursement will be less than the pharmacy’s cost of acquisition does not interfere with central matters of plan administration. The responsi- bility for offering the pharmacy a below-acquisition reimbursement lies first with the PBM. Finally, any “operational inefficiencies” caused by Act 900 are insufficient to trigger ERISA pre-emption, even if they cause plans to limit benefits or charge plan members higher rates. See De Buono v. NYSA–ILA Medical and Clinical Services Cite as: 592 U. S. ____ (2020) 3

Fund, 520 U. S. 806, 816. Pp. 7–10. 891 F. 3d 1109, reversed and remanded.

SOTOMAYOR, J., delivered the opinion of the Court, in which all other Members joined, except BARRETT, J., who took no part in the considera- tion or decision of the case. THOMAS, J., filed a concurring opinion. Cite as: 592 U. S. ____ (2020) 1

Opinion of the Court

NOTICE: This opinion is subject to formal revision before publication in the preliminary print of the United States Reports. Readers are requested to notify the Reporter of Decisions, Supreme Court of the United States, Wash- ington, D. C. 20543, of any typographical or other formal errors, in order that corrections may be made before the preliminary print goes to press.

SUPREME COURT OF THE UNITED STATES _________________

No. 18–540 _________________

LESLIE RUTLEDGE, ATTORNEY GENERAL OF ARKANSAS, PETITIONER v. PHARMA- CEUTICAL CARE MANAGEMENT ASSOCIATION ON WRIT OF CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE EIGHTH CIRCUIT [December 10, 2020]

JUSTICE SOTOMAYOR delivered the opinion of the Court. Arkansas’ Act 900 regulates the price at which pharmacy benefit managers reimburse pharmacies for the cost of drugs covered by prescription-drug plans. The question presented in this case is whether the Employee Retirement Income Security Act of 1974 (ERISA), 88 Stat. 829, as amended, 29 U. S. C. §1001 et seq., pre-empts Act 900. The Court holds that the Act has neither an impermissible con- nection with nor reference to ERISA and is therefore not pre-empted. I A Pharmacy benefit managers (PBMs) are a little-known but important part of the process by which many Americans get their prescription drugs.

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

Related

Untitled Texas Attorney General Opinion: KP-0480
Texas Attorney General Reports, 2025
Orabona v. Santander Bank, N.A.
D. Rhode Island, 2024
Standard Ins. Co. v. Joel Michael Guy, Jr.
115 F.4th 518 (Sixth Circuit, 2024)
BURNS v. COOPER
E.D. Pennsylvania, 2024

Cite This Page — Counsel Stack

Bluebook (online)
592 U.S. 80, 208 L. Ed. 2d 327, 141 S. Ct. 474, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rutledge-v-pharmaceutical-care-management-assn-scotus-2020.