United States Sixth Circuit

In a declaratory action brought by a pharmaceutical-services company seeking declaration that certain pharmacy-benefit plan restrictions apply to a state agency's third party claims, summary judgment against plaintiff is affirmed where: 1) 42 U.S.C. section 1396a(a)(25)(I) and its legislative history established that "card presentation" and "timely filing" restrictions were impermissible grounds on which to deny reimbursement to a state Medicaid agency; 2) there was no error in a holding that a Tennessee Medicaid beneficiary's assignment of rights to state agency occurs at the point-of-sale; 3) the restrictions were invalid as applied because they violate Medicaid's anti-discrimination policies; and 4) ERISA requires health benefit plans to allow state Medicaid agencies to obtain reimbursement for Medicaid expenditures.

Appellate Information

• Decided 03/13/2007
• Published 03/13/2007

Judges

• Before: KEITH and COLE, Circuit Judges;  STEEH, District Judge.

Court

• United States Sixth Circuit

Counsel

• For Appellees:
  
• ARGUED:  Jennifer L. Weaver, Waller, Lansden, Dortch & Davis, Nashville, Tennessee, for Appellant.  Peter M. Coughlan, Office of the Attorney General, Nashville, Tennessee, for Appellees.   Tara Leigh Grove, United States Department of Justice, Washington, D.C., for Intervenor.   ON BRIEF:  Jennifer L. Weaver, Paul S. Davidson, Waller, Lansden, Dortch & Davis, Nashville, Tennessee, for Appellant. Peter M. Coughlan, Office of the Attorney General, Nashville, Tennessee, for Appellees.   William Kanter, Anne Murphy, United States Department of Justice, Washington, D.C., for Intervenor.