Rutledge v. Pharmaceutical Care Management Assn.

592 U.S. 80, 208 L. Ed. 2d 327, 141 S. Ct. 474
Supreme Court of the United States·Decided December 10, 2020·No. 18-540·Published·Cited by 66 cases

Opinions

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

Syllabus

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 pharmacies and prescription-drug plans. In that role, they reimburse pharmacies 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 Arkansas 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 administrative 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 acquisition cost. §17–92–507(e). Respondent Pharmaceutical Care Management 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

v. Egelhoff, 532 U. S. 141, 147. Act 900 has neither of those impermissible 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 administration .” 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 substantive coverage are not pre-empted by ERISA. See New York State Conference 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] immediately 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 nationally 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 procedure 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 mechanisms 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 reimbursement will be less than the pharmacy’s cost of acquisition does not interfere with central matters of plan administration. The responsibility 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

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 consideration or decision of the case. THOMAS, J., filed a concurring opinion.

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

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