ASTRAZENECA LP v. State’s Empirical Analysis

Citation profile

4 state decisions

Most-quoted passages

The sentences later courts lift from this opinion, ranked by how many decisions quote each — the parts of the opinion doing the work. These counts are smaller than the citation total above because most of the 8 citing decisions cite the case generally; a passage count includes only decisions quoting that exact language verbatim.

1. ““In the 1970s, the AMA merely reimbursed providers on the basis of their actual acquisition price.... [I]n the early 1980s, the AMA began reimbursing providers at a rate of 100% of AWP. 3 “In June 1985, however, Richard Morris, associate regional administrator of the Department of Health and Human Services (‘the DHHS’) sent a letter to then AMA Commissioner Faye Baggi-ano (‘the Morris letter’), threatening to withdraw federal financial participation from the Alabama Medicaid program because of the AMA’s use of 100% of AWP as the basis for reimbursement. The letter stated: “ ‘This is to inform you of corrective action being pursued by this office to secure compliance with Federal regulations regarding Medicaid prescription drug reimbursement and to request your assistance in implementing certain changes by October 1, 1985. “ ‘The Federal regulations at 42 CFR [§ ] 447.881 [currently 42 C.F.R. § 447.512 ] provide that the State Agency may not pay more for prescribed drugs than the lower of ingredient cost plus a reasonable dispensing fee or the provider’s usual and customary charge to the general public. Costs for certain multiple source drugs are subject to the ... “estimated acquisition cost” (EAC) ... as published in the Federal Register. For all other drugs, the allowable cost limit is the State Agency’s best estimate of what price providers generally are paying based on the package size providers most frequently purchase — 42 C.F.R. [§ ] 447.332(c). “ ‘As early as 1975 the”

   1 later decision quote this exact passage
   e.g. Sandoz, Inc. v. State

2. ““ ‘The Medicaid program was created in 1965, when Congress added Title XIX to the Social Security Act, 79 Stat. 343 , as amended, 42 U.S.C. § 1396 et seq. ... [ (“the Medicaid Act”) ], for the purpose of providing federal financial assistance to States that choose to reimburse certain costs of medical treatment for needy persons.’ Harris v. McRae, 448 U.S. 297, 301 , 100 S.Ct. 2671 , 65 L.Ed.2d 784 (1980). ‘Although participation in the Medicaid program is entirely optional, once a State elects to participate, it must comply with the requirements of Title XIX.’ 448 U.S. at 301 , 100 S.Ct. 2671 . Medicaid provides ‘joint federal and state funding of medical care for individuals who cannot afford to pay their own medical costs.’ Arkansas Dep’t of Health & Human Servs. v. Ahlborn, 547 U.S. 268, 275 , 126 S.Ct. 1752 , 164 L.Ed.2d 459 (2006). The ‘[federal financial participation,’ 42 C.F.R. § 430.1 , was, during the time relevant to this dispute, approximately 70% of the amount of the expense the [Alabama Medicaid Agency] incurred under its Medicaid program. “At the federal level, Medicaid is administered by the Centers for Medicaid and Medicare Services (‘the CMS’), formerly known as the Health Care Financing Administration [ (‘the HCFA’) ]. See Centers for Medicare & Medicaid Services; Statement of Organization, Functions and Delegations of Authority; Reorganization Order, 66 Fed.Reg. 35,437 (July 5, 2001); Statement of Organization, Functions, and Delegations of Authority, 49 ”

   1 later decision quote this exact passage
   e.g. Sandoz, Inc. v. State

3. ““by 1985, the AMA was reimbursing providers at the [AWP] rate. Significantly, in that same year, the AMA received a warning from the DHHS [Department of Health and Human Services] that the State stood to lose federal financial participation if the AMA continued to reimburse on the basis of an undiscounted AWP. The Morris letter clearly stated that published AWPs were being inflated by ‘an average of 15.96 percent.’ Morris demanded that the AMA formulate a methodology that discounted the published AWP ‘significantly to reflect a more accurate representation of the true estimated acquisition cost of a drug....’ “The Morris letter set in motion the process culminating in the AMA’s current reimbursement methodology. First, then Commissioner Baggiano notified Morris of the AMA’s intent to adopt a methodology based on WAC + 5.01%, which, according to the Finch memo, corresponded to a discount from AWP of approximately 13.5%. This intent was then communicated on September 6, 1985, to ‘all pharmacies ... participating in the Alabama Title XIX (Medicaid) Pharmaceutical Program’ through Notice 85-18. In Notice 85-18, the AMA itself acknowledged that ‘published AWPs ... are inflated and ... [are] not the [AMA’s] “best estimate” of what price providers generally are paying for a drug.’ (Emphasis added.) “The experience of Commissioner [Steckel] provides further evidence of the AMA’s actual knowledge of the true meaning of AWP. The Initiative she received in 1987 while she worked for the ”

   1 later decision quote this exact passage · from the concurrence
   e.g. Sandoz, Inc. v. State