ILNews

Judge blocks Medicaid fee cut to pharmacies

Back to TopCommentsE-mailPrintBookmark and Share

A federal judge in Indianapolis has temporarily blocked the state from cutting the fees it pays to pharmacists for dispensing Medicaid prescriptions.

On July 8, U.S. Judge Tanya Walton Pratt in the Southern District of Indiana granted a temporary restraining order against the Indiana Family and Social Services Administration and its Office of Medicaid Policy and Planning. Her decision came a week after the non-profit Community Pharmacies of Indiana and Williams Brothers Health Care Pharmacy in southern Indiana filed a suit challenging the new policy that would have taken effect July 1.

Specifically, the lawsuit challenges a 38 percent cut in the Medicaid pharmacy-dispensing fee; meaning pharmacies would receive $3 instead of $4.90 for preparing and dispensing any particular drug under the Medicaid program.

The lawsuit alleges the cut violates the federal Medicaid law because the state FSSA secretary didn’t approve the fee reduction as required and that runs contrary to the Supremacy Clause of the U.S. Constitution. The suit also alleges the fee reduction violates Indiana Code 12-15-13-2, which states that Indiana Medicaid providers must offer services to program recipients similar to what the general population might receive.

The plaintiffs argue that if imposed, the cut could result in pharmacies closing and patients being unable to access their needed medications.

But the state disagreed, saying the reduced rate was aimed at making sure Indiana met the $212 million budget reduction mandated by the General Assembly. In a brief filed July 6, the Indiana attorney general’s office also contended that the non-profit group representing 170 local pharmacies statewide isn’t a Medicaid recipient and shouldn’t be able to challenge a federal program designed for patients, not pharmacies.

“Requiring the State to continue to reimburse Plaintiffs under the old rate would negate the purpose of the Medicaid Act and would not in any way serve the poor and aged – the intended beneficiaries of the Medicaid Act,” the state’s brief says.

Judge Pratt ruled in favor of the plaintiffs, but noted in her grant of the temporary restraining order that both sides present compelling arguments and she still has some question about whether a private cause of action exists here.

Caselaw dictates that the Supremacy Clause doesn’t create rights for Medicaid Act providers to sue for enforcement, and Judge Pratt agreed that no authority supports the notion that the statute includes right-creating language directed at those providers.

But those arguments weren’t enough to persuade her to the state’s side.

In her decision, Judge Pratt determined the IFSSA acted prematurely in cutting the dispensing fee before the reduction was approved by the U.S. Department of Health and Human Resources. That reduction is irreconcilable to the federal statute and would cause many pharmacies to “continue to hemorrhage dollars” and affect their ability to continue providing Medicaid services, she wrote.

The judge wrote that precedent from both the U.S. Supreme Court and the 7th Circuit Court of Appeals recognizes the availability of injunctive relief to enjoin state officers from implementing a rule or regulation that’s preempted under the Supremacy Clause, and the plaintiffs don’t have to show the Medicaid Act confers a private right of action for injunctive relief.

“Obviously, this harm could trickle down to Medicaid patients who constitute the poor, the elderly, the disabled and families with children, many of whom reside in rural areas with a dearth of other pharmacy options within close proximity,” she wrote.

A briefing scheduled is being worked out with U.S. Magistrate Judge Denise LaRue, and Judge Pratt has set a hearing on the preliminary injunction for Aug. 24.

ADVERTISEMENT

Post a comment to this story

COMMENTS POLICY
We reserve the right to remove any post that we feel is obscene, profane, vulgar, racist, sexually explicit, abusive, or hateful.
 
You are legally responsible for what you post and your anonymity is not guaranteed.
 
Posts that insult, defame, threaten, harass or abuse other readers or people mentioned in Indiana Lawyer editorial content are also subject to removal. Please respect the privacy of individuals and refrain from posting personal information.
 
No solicitations, spamming or advertisements are allowed. Readers may post links to other informational websites that are relevant to the topic at hand, but please do not link to objectionable material.
 
We may remove messages that are unrelated to the topic, encourage illegal activity, use all capital letters or are unreadable.
 

Messages that are flagged by readers as objectionable will be reviewed and may or may not be removed. Please do not flag a post simply because you disagree with it.

Sponsored by
ADVERTISEMENT
Subscribe to Indiana Lawyer
  1. It's an appreciable step taken by the government to curb the child abuse that are happening in the schools. Employees in the schools those are selected without background check can not be trusted. A thorough background check on the teachers or any other other new employees must be performed to choose the best and quality people. Those who are already employed in the past should also be checked for best precaution. The future of kids can be saved through this simple process. However, the checking process should be conducted by the help of a trusted background checking agency(https://www.affordablebackgroundchecks.com/).

  2. Almost everything connects to internet these days. From your computers and Smartphones to wearable gadgets and smart refrigerators in your home, everything is linked to the Internet. Although this convenience empowers usto access our personal devices from anywhere in the world such as an IP camera, it also deprives control of our online privacy. Cyber criminals, hackers, spies and everyone else has realized that we don’t have complete control on who can access our personal data. We have to take steps to to protect it like keeping Senseless password. Dont leave privacy unprotected. Check out this article for more ways: https://www.purevpn.com/blog/data-privacy-in-the-age-of-internet-of-things/

  3. You need to look into Celadon not paying sign on bonuses. We call get the run

  4. My parents took advantage of the fact that I was homeless in 2012 and went to court and got Legal Guardianship I my 2 daughters. I am finally back on my feet and want them back, but now they want to fight me on it. I want to raise my children and have them almost all the time on the weekends. Mynparents are both almost 70 years old and they play favorites which bothers me a lot. Do I have a leg to stand on if I go to court to terminate lehal guardianship? My kids want to live with me and I want to raise them, this was supposed to be temporary, and now it is turning into a fight. Ridiculous

  5. Here's my two cents. While in Texas in 2007 I was not registered because I only had to do it for ten years. So imagine my surprise as I find myself forced to register in Texas because indiana can't get their head out of their butt long enough to realize they passed an ex post facto law in 2006. So because Indiana had me listed as a failure to register Texas said I had to do it there. Now if Indiana had done right by me all along I wouldn't need the aclu to defend my rights. But such is life.

ADVERTISEMENT