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Judge blocks Medicaid fee cut to pharmacies

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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.

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  1. I wonder if the USSR had electronic voting machines that changed the ballot after it was cast? Oh well, at least we have a free media serving as vicious watchdog and exposing all of the rot in the system! (Insert rimshot)

  2. Jose, you are assuming those in power do not wish to be totalitarian. My experience has convinced me otherwise. Constitutionalists are nearly as rare as hens teeth among the powerbrokers "managing" us for The Glorious State. Oh, and your point is dead on, el correcta mundo. Keep the Founders’ (1791 & 1851) vision alive, my friend, even if most all others, and especially the ruling junta, chase only power and money (i.e. mammon)

  3. Hypocrisy in high places, absolute immunity handed out like Halloween treats (it is the stuff of which tyranny is made) and the belief that government agents are above the constitutions and cannot be held responsible for mere citizen is killing, perhaps has killed, The Republic. And yet those same power drunk statists just reel on down the hallway toward bureaucratic fascism.

  4. Well, I agree with you that the people need to wake up and see what our judges and politicians have done to our rights and freedoms. This DNA loophole in the statute of limitations is clearly unconstitutional. Why should dna evidence be treated different than video tape evidence for example. So if you commit a crime and they catch you on tape or if you confess or leave prints behind: they only have five years to bring their case. However, if dna identifies someone they can still bring a case even fifty-years later. where is the common sense and reason. Members of congress are corrupt fools. They should all be kicked out of office and replaced by people who respect the constitution.

  5. If the AG could pick and choose which state statutes he defended from Constitutional challenge, wouldn't that make him more powerful than the Guv and General Assembly? In other words, the AG should have no choice in defending laws. He should defend all of them. If its a bad law, blame the General Assembly who presumably passed it with a majority (not the government lawyer). Also, why has there been no write up on the actual legislators who passed the law defining marriage? For all the fuss Democrats have made, it would be interesting to know if some Democrats voted in favor of it (or if some Republican's voted against it). Have a nice day.

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