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Pharm. Care Mgmt. Ass'n v. Wehbi

Pharm. Care Mgmt. Ass'n v. Wehbi

United States Court of Appeals for the Eighth Circuit

September 1, 2021, Submitted; November 17, 2021, Filed

No. 18-2926

Opinion

 [*964]  [**4]  GRUENDER, Circuit Judge.

Pharmaceutical Care Management Association ("PCMA") sued to enjoin the enforcement of several North Dakota statutory provisions, claiming that they were preempted by the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq., and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ("Medicare Part D"), 42 U.S.C. § 1395w-101 et seq. The district court concluded that ERISA preempted none of the challenged provisions and that Medicare Part D preempted only one. Pharm. Care Mgmt. Ass'n v. Tufte, 326 F. Supp. 3d 873 (D.N.D. 2018), aff'd in part, rev'd in part, 968 F.3d 901 (8th Cir. 2020), vacated sub nom. Wilke v. Pharm. Care Mgmt. Ass'n, 141 S. Ct. 1364, 209 L. Ed. 2d 114 (2021) (mem.). PCMA appealed, and we reversed on the issue of ERISA preemption. Tufte, 968 F.3d 901. Subsequently, the Supreme Court vacated our judgment and remanded for us to reconsider the case in light of Rutledge v. Pharmaceutical Care Management Association, 592 U.S.    , 141 S. Ct. 474, 208 L. Ed. 2d 327 (2020). Wilke, 141 S. Ct. 1364. Having done so, we affirm in part and reverse in part.

In 2017, North Dakota enacted two laws, codified at North Dakota Century Code sections 19-02.1-16.1 and -16.2. The laws regulate entities known as "pharmacy benefits managers" ("PBMs") that manage prescription-drug benefits on behalf of health-insurance plans. The relevant provisions in section 16.1 read as follows:

2. A pharmacy benefits manager or third-party payer may not directly or indirectly charge or hold a pharmacy responsible for a fee related to a claim:

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18 F.4th 956 *; 2021 U.S. App. LEXIS 34064 **; 2021 WL 5359407

Pharmaceutical Care Management Association, Plaintiff - Appellant v. Nizar Wehbi, in his official capacity as the State Health Officer of North Dakota; Mark J. Hardy, in his official capacity as the Executive Director of the North Dakota Board of Pharmacy; Tyler Lannoye, in his official capacity as the President of the North Dakota Board of Pharmacy; Wayne Stenehjem, in his official capacity as the Attorney General of North Dakota, Defendants - Appellees;The Chamber of Commerce of the United States of America; America's Health Insurance Plans; Association of Federal Health Organizations, Amici on Behalf of Appellant(s) National Association of Chain Drug Stores; National Council of Insurance Legislators; State of Minnesota; State of Alaska; State of Arizona; State of Arkansas; State of California; State of Colorado; State of Connecticut; State of Delaware; State of Georgia; State of Hawaii; State of Illinois; State of Indiana; State of Maine; State of Maryland; State of Massachusetts; State of Michigan; State of Mississippi; State of Nebraska; State of Nevada; State of New Jersey; State of New Mexico; State of New York; State of North Carolina; State of Oklahoma; State of Oregon; State of Rhode Island; State of South Carolina; State of South Dakota; State of Texas; State of Utah; State of Vermont; State of Virginia; State of Washington; District of Columbia; National Community Pharmacists Association; American Pharmacists Association; North Dakota Pharmacists Association; Arkansas Pharmacists Association; Iowa Pharmacists Association; Minnesota Pharmacists Association; Missouri Pharmacists Association; Nebraska Pharmacists Association; South Dakota Pharmacists Association; Alliance for Transparent and Affordable Prescriptions; Community Oncology Alliance; American Pharmacies, Amici on Behalf of Appellee(s)

Subsequent History: Rehearing denied by, En banc, Rehearing denied by Pharm. Care Mgmt. Ass'n v. Wehbi, 2022 U.S. App. LEXIS 3924 (8th Cir. N.D., Feb. 11, 2022)

Prior History:  [**1] Appeal from United States District Court for the District of North Dakota - Bismarck.

Pharm. Care Mgmt. Ass'n v. Tufte, 326 F. Supp. 3d 873, 2018 U.S. Dist. LEXIS 150655, 2018 WL 4222870 (D.N.D., Sept. 5, 2018)

CORE TERMS

pharmacy, preempted, plans, preemption, regulation, state law, benefits, drugs, challenged provision, express preemption provision, patient, third-party, federal standard, formulary, network, mail, challenged portion, conditions, provisions, dispense, sponsor, district court, federal law, adjudicated, impliedly, prohibits, disclose, displace, subject matter, negotiations

Civil Procedure, Summary Judgment, Entitlement as Matter of Law, Appropriateness, Appellate Review, Standards of Review, Judgments, Entitlement as Matter of Law, Appeals, Standards of Review, De Novo Review, Genuine Disputes, Business & Corporate Compliance, ERISA, Fiduciaries, Named Fiduciary Appointment & Obligations, Pensions & Benefits Law, Federal Preemption, Definitions, State Laws, Exempt Plans, Mandated Plans, Constitutional Law, Supremacy Clause, Federal Preemption, Supreme Law of the Land, Federal & State Interrelationships, Federal Common Law, Preemption, Public Health & Welfare Law, Social Security, Medicare, Eligibility, Medicare Act Interpretation, Coverage, Part B Medical Insurance, Judicial Review, Medicaid, Pharmaceutical Services, Public Contracts Law, Costs & Prices, Cost Accounting Standards, Civil Rights Law, Protection of Rights, Conspiracy Against Rights, Obstruction of Judicial Processes, Banking Law, Consumer Protection, Truth in Lending, Disclosure, State Law, Banking & Finance, Federal Acts, Home Owners' Loan Act, Part A Hospital Insurance