Breaking News: APRx Appeals Medicaid Rx Ruling

April 26, 2012

BREAKING NEWS:

APRx Continuing Medicaid Fight

With Appeal of State Court Ruling

American Pharmacies has filed an appeal of the April 24 ruling that dismissed APRx's lawsuit against Texas Health and Human Services Commission (HHSC) over the implementation of managed care for Medicaid pharmacy benefits.

The appeal was filed this afternoon (April 26) in the Texas Third Court of Appeals in Austin.

The lawsuit, filed and financed by American Pharmacies on behalf of all Texas pharmacies, had asked the court to find that the Texas Vendor Drug Program payment rates in effect through Feb. 29 govern payments made through MCOs. It also asked the court to strike down HHSC's new regulations for failing to consider less onerous alternatives for small-business pharmacies.

Without providing any reasons for his findings, State District Court Judge John Dietz ruled on Tuesday that APRx failed to prove its case, and denied our request for relief by injunction. In a narrowly focused one-day trial a day earlier in Austin, APRx outside counsel Miguel Rodriguez had argued that HHSC is obligated by state law to establish rules and standards governing the determination of Medicaid payments made to pharmacy providers, even if those payments are made by managed care organizations (MCOs) and PBMs.

APRx continues to believe strongly that HHSC's decision to allow MCOs and their subcontracted PBMs to arbitrarily establish drastically low reimbursement schemes violates state law.

APRx also has a Medicaid lawsuit pending in federal court. That suit, filed in February in U.S. District Court (Western District of Texas, Austin Division), asks the federal judge to find that Commissioner Suehs is violating federal regulations by failing to require MCOs to reimburse Texas pharmacies at rates established in the VDP as previously approved by federal regulators. The suit also asks the federal judge to find that anything different from this method of reimbursement is a violation of federal law pre-empted by the Supremacy Clause of the U.S. Constitution.

Questions? Contact our legal team: afields@aprx.org and mrodriguez@taylordunham.com.

VDP's Updated MAC List Effective 5/3

The Medicaid/CHIP Vendor Drug Program has updated the list of Maximum Allowable Cost drugs with new prices taking effect next Thursday May 3. The VDP's MAC list applies only to pharmacy benefits for Medicaid patients who are not covered by managed care.

► Medicaid Formulary Info
► See New MAC List