Case:
Karen L. et al v. Health Net, PHS, et al.
___ F.2d ___, 2003 U.S. App. LEXIS 21963 (2nd Cir. 2003)
Medicaid :
Second Circuit Court of Appeals
October 24, 2003
The
Second Circuit Court of Appeals affirmed a lower court's denial
of plaintiffs' request for a preliminary injunction on behalf of
all Health Net Medicaid recipients seeking to challenge the Medicaid
Managed Care Organization's ("MCO") pre-authorization prescription
plan as part of a "reclassification" program. In Karen L. v. Health
Net, et al, the circuit court found that the district court had
not abused its discretion because its decision had not rested on
an error of law or a clearly erroneous factual finding. The district
court's rationale -- namely that there was no evidence to show that
any Medicaid recipient was threatened by denying Medicaid recipients
non-formulary medications -- met the legal standard because the
MCO had send the recipients, as well as their physicians and pharmacists,
a notice indicating the change and encouraging patients and physicians
to notify Health Net if the drug was medically necessary. The brief
decision may be accessed on the Second Circuit Court of Appeal's
web site by going to http://www.ca2.uscourts.gov/.
